Provider Demographics
NPI:1710696224
Name:AGAPE WOUND CARE CENTER INCORPORATED
Entity Type:Organization
Organization Name:AGAPE WOUND CARE CENTER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHULTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-996-5255
Mailing Address - Street 1:PO BOX 971414
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79997-1414
Mailing Address - Country:US
Mailing Address - Phone:915-996-5255
Mailing Address - Fax:915-975-7997
Practice Address - Street 1:1721A N LEE TREVINO DR STE 103
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4521
Practice Address - Country:US
Practice Address - Phone:915-996-5255
Practice Address - Fax:915-591-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty