Provider Demographics
NPI:1740574045
Name:C H WILKINSON PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:C H WILKINSON PHYSICIAN NETWORK
Other - Org Name:CHRISTUS SPOHN MEDICAL GROUP SHORELINE ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-277-2209
Mailing Address - Street 1:2726 HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-5709
Mailing Address - Country:US
Mailing Address - Phone:361-727-9994
Mailing Address - Fax:361-861-9022
Practice Address - Street 1:2726 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-5709
Practice Address - Country:US
Practice Address - Phone:361-727-9994
Practice Address - Fax:361-861-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty