Provider Demographics
NPI:1619101284
Name:MITCH C WOLFE MD PA
Entity Type:Organization
Organization Name:MITCH C WOLFE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-538-5054
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-0180
Mailing Address - Country:US
Mailing Address - Phone:940-538-5054
Mailing Address - Fax:940-538-0028
Practice Address - Street 1:310 W SOUTH ST
Practice Address - Street 2:#101
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365-3346
Practice Address - Country:US
Practice Address - Phone:940-538-5054
Practice Address - Fax:940-538-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty