Provider Demographics
NPI:1972934362
Name:WOUND HEALING ASSOCIATES OF SETX PA
Entity Type:Organization
Organization Name:WOUND HEALING ASSOCIATES OF SETX PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:B
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-223-1145
Mailing Address - Street 1:11844 BANDERA RD
Mailing Address - Street 2:PMB 452
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4132
Mailing Address - Country:US
Mailing Address - Phone:210-223-1145
Mailing Address - Fax:210-615-7619
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:SUITE 502
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2516
Practice Address - Country:US
Practice Address - Phone:210-223-1145
Practice Address - Fax:210-615-7619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL14192083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0030ZPOtherBCBS ID
TX362607901Medicaid
529252OtherMEDICARE PTAN