Provider Demographics
NPI:1508954892
Name:WIC, LTD.
Entity Type:Organization
Organization Name:WIC, LTD.
Other - Org Name:WACO OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-772-5612
Mailing Address - Street 1:105 OLD HEWITT RD
Mailing Address - Street 2:200
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6549
Mailing Address - Country:US
Mailing Address - Phone:254-772-5612
Mailing Address - Fax:254-772-5617
Practice Address - Street 1:105 OLD HEWITT RD
Practice Address - Street 2:200
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6549
Practice Address - Country:US
Practice Address - Phone:254-772-5612
Practice Address - Fax:254-772-5617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)