Provider Demographics
NPI:1437170065
Name:C.H. WILKINSON PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:C.H. WILKINSON PHYSICIAN NETWORK
Other - Org Name:CHRISTUS MEDICAL GROUP SANTA ROSA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-636-1805
Mailing Address - Street 1:HIGHWAY 107 & LA FERIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:TX
Mailing Address - Zip Code:78593
Mailing Address - Country:US
Mailing Address - Phone:956-636-1805
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 107 & LA FERIA AVENUE
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:2006-07-21
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458981Medicare Oscar/Certification