Provider Demographics
NPI:1225469703
Name:WRIST & HAND CENTER OF WACO, PLLC
Entity Type:Organization
Organization Name:WRIST & HAND CENTER OF WACO, PLLC
Other - Org Name:WACO HAND, ELBOW & WRIST, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAILLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-732-0005
Mailing Address - Street 1:7003 WOODWAY DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6170
Mailing Address - Country:US
Mailing Address - Phone:254-732-0005
Mailing Address - Fax:
Practice Address - Street 1:7003 WOODWAY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-6170
Practice Address - Country:US
Practice Address - Phone:254-732-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4106207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341943YY8EMedicare PIN
7023970001Medicare NSC