Provider Demographics
NPI:1013357953
Name:EXALTED WORLDWIDE, PLLC
Entity Type:Organization
Organization Name:EXALTED WORLDWIDE, PLLC
Other - Org Name:KAIROS RESTORATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:940-318-9400
Mailing Address - Street 1:1912 LOOP 11
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-4921
Mailing Address - Country:US
Mailing Address - Phone:940-318-9400
Mailing Address - Fax:
Practice Address - Street 1:1912 LOOP 11
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306-4921
Practice Address - Country:US
Practice Address - Phone:940-318-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty