Provider Demographics
NPI:1356859615
Name:LYMPHEDEMA & WOUND INSTITUTE, INC.
Entity Type:Organization
Organization Name:LYMPHEDEMA & WOUND INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-338-2590
Mailing Address - Street 1:PO BOX 58598
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8598
Mailing Address - Country:US
Mailing Address - Phone:281-338-2590
Mailing Address - Fax:281-338-2594
Practice Address - Street 1:845 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3942
Practice Address - Country:US
Practice Address - Phone:281-338-2590
Practice Address - Fax:281-338-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center