Provider Demographics
NPI:1669475075
Name:MEDWISE, LTD
Entity Type:Organization
Organization Name:MEDWISE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-934-4500
Mailing Address - Street 1:350 N SAM HOUSTON PKWY E
Mailing Address - Street 2:STE 271
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3333
Mailing Address - Country:US
Mailing Address - Phone:713-934-4500
Mailing Address - Fax:800-215-4840
Practice Address - Street 1:350 N SAM HOUSTON PKWY E
Practice Address - Street 2:STE 271
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3333
Practice Address - Country:US
Practice Address - Phone:713-934-4500
Practice Address - Fax:800-215-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD380004100Medicaid
TX016679501Medicaid
KS100337150BMedicaid
MS440595Medicaid
KY900002031Medicaid
OK100245580BMedicaid
TN4582106Medicaid
TX530690OtherBCBS
PA1014670270001Medicaid
WA902730Medicaid
AZ136931716Medicaid
LA1554928Medicaid
IN200512210AMedicaid
TX091542301Medicaid
OH2103557Medicaid
IA518985Medicaid
TN4582106Medicaid
WA902730Medicaid