Provider Demographics
NPI:1265443030
Name:WICHITA FALLS INFECTIOUS DISEASE ASSOC. P.A.
Entity Type:Organization
Organization Name:WICHITA FALLS INFECTIOUS DISEASE ASSOC. P.A.
Other - Org Name:ROBERT L MCBROOM MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROOKING
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM, CMIS
Authorized Official - Phone:940-723-9226
Mailing Address - Street 1:1601 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5619
Mailing Address - Country:US
Mailing Address - Phone:940-723-9226
Mailing Address - Fax:940-723-9217
Practice Address - Street 1:1601 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5619
Practice Address - Country:US
Practice Address - Phone:940-723-9226
Practice Address - Fax:940-723-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6922174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC19018Medicare UPIN
TX00405YMedicare PIN