Provider Demographics
NPI:1225130578
Name:C H WILKINSON PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:C H WILKINSON PHYSICIAN NETWORK
Other - Org Name:CHRISTUS MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKULECKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-681-8877
Mailing Address - Street 1:2600 NORTH LOOP W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8903
Mailing Address - Country:US
Mailing Address - Phone:713-681-8877
Mailing Address - Fax:713-812-2063
Practice Address - Street 1:HIGHWAY 107 AND LA FERIA AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:TX
Practice Address - Zip Code:78593
Practice Address - Country:US
Practice Address - Phone:956-636-1805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7201261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health