Provider Demographics
NPI:1760465173
Name:TEXAS WELLNESS HEALTH GROUP, PLLC
Entity Type:Organization
Organization Name:TEXAS WELLNESS HEALTH GROUP, PLLC
Other - Org Name:WOMENS HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-581-2168
Mailing Address - Street 1:5208 N 10TH ST # 4016
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2701
Mailing Address - Country:US
Mailing Address - Phone:956-581-2168
Mailing Address - Fax:956-581-2169
Practice Address - Street 1:3001 N 23RD ST STE 1
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6179
Practice Address - Country:US
Practice Address - Phone:956-581-2168
Practice Address - Fax:956-581-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2458207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147538601Medicaid
TX147538601Medicaid
F33456Medicare UPIN