Provider Demographics
NPI:1831287218
Name:WILMAR HEALTHCARE SYSTEMS, INC.
Entity Type:Organization
Organization Name:WILMAR HEALTHCARE SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-988-2956
Mailing Address - Street 1:10103 FONDREN RD STE 475
Mailing Address - Street 2:475
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4671
Mailing Address - Country:US
Mailing Address - Phone:713-988-2956
Mailing Address - Fax:713-988-4855
Practice Address - Street 1:10103 FONDREN RD STE 475
Practice Address - Street 2:475
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4671
Practice Address - Country:US
Practice Address - Phone:713-988-2956
Practice Address - Fax:713-988-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23456103T00000X
TXG9623207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147163303Medicaid
TX147163302Medicaid
00960TMedicare ID - Type Unspecified