Provider Demographics
NPI:1942356043
Name:CH WILKINSON PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:CH WILKINSON PHYSICIAN NETWORK
Other - Org Name:CHRISTUS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKULECKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-277-2208
Mailing Address - Street 1:1311 GENERAL CAVAZOS BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-7129
Mailing Address - Country:US
Mailing Address - Phone:361-592-2223
Mailing Address - Fax:361-592-1967
Practice Address - Street 1:2601 HOSPITAL BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1815
Practice Address - Country:US
Practice Address - Phone:361-592-2223
Practice Address - Fax:361-592-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020BDMedicare PIN