Provider Demographics
NPI:1891936266
Name:WOUND PROFESSIONAL SERVICES OF HOUSTON
Entity Type:Organization
Organization Name:WOUND PROFESSIONAL SERVICES OF HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-301-5707
Mailing Address - Street 1:25000 PITKIN RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2467
Mailing Address - Country:US
Mailing Address - Phone:713-301-5707
Mailing Address - Fax:713-295-2863
Practice Address - Street 1:25000 PITKIN RD
Practice Address - Street 2:SUITE 280
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77386-2467
Practice Address - Country:US
Practice Address - Phone:713-301-5707
Practice Address - Fax:713-295-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8104208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125858404Medicaid
88Y442Medicare PIN
TXB22697Medicare UPIN