Provider Demographics
NPI:1215587977
Name:TEXAS WOUND PROS LLC
Entity Type:Organization
Organization Name:TEXAS WOUND PROS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-252-7808
Mailing Address - Street 1:4601 OLD SHEPARD PL STE 302
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5279
Mailing Address - Country:US
Mailing Address - Phone:469-606-0100
Mailing Address - Fax:949-404-8632
Practice Address - Street 1:4601 OLD SHEPARD PL STE 302
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5279
Practice Address - Country:US
Practice Address - Phone:469-606-0010
Practice Address - Fax:949-404-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty