Provider Demographics
NPI:1225321946
Name:3CVO MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:3CVO MEDICAL GROUP, PLLC
Other - Org Name:ASSOCIATION OF WOUND CARE EXPERTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-731-6121
Mailing Address - Street 1:PO BOX 26804
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-0804
Mailing Address - Country:US
Mailing Address - Phone:817-731-6121
Mailing Address - Fax:817-732-8015
Practice Address - Street 1:730 EUREKA ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6546
Practice Address - Country:US
Practice Address - Phone:817-731-6121
Practice Address - Fax:817-732-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB132564Medicare PIN
TXTXB132565Medicare PIN