Provider Demographics
NPI:1801371349
Name:CAPITAL ADVANCED WOUND CARE PLLC
Entity Type:Organization
Organization Name:CAPITAL ADVANCED WOUND CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-703-9990
Mailing Address - Street 1:PO BOX 16639
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6639
Mailing Address - Country:US
Mailing Address - Phone:979-282-6151
Mailing Address - Fax:800-559-8401
Practice Address - Street 1:2011 FM 102 RD
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-8833
Practice Address - Country:US
Practice Address - Phone:979-282-6151
Practice Address - Fax:800-559-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX394865501Medicaid