Provider Demographics
NPI:1508912221
Name:LYMPHEDEMA & WOUNDCARE INSTITUTE
Entity Type:Organization
Organization Name:LYMPHEDEMA & WOUNDCARE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-236-7926
Mailing Address - Street 1:PO BOX 20306
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77225-0306
Mailing Address - Country:US
Mailing Address - Phone:713-526-7926
Mailing Address - Fax:281-786-1966
Practice Address - Street 1:10023 MAIN ST STE C8
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5252
Practice Address - Country:US
Practice Address - Phone:713-526-7926
Practice Address - Fax:281-786-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5803665OtherCIGNA
TX8CQ775OtherBC/BS
TX8CQ775OtherBC/BS