Provider Demographics
NPI:1124446836
Name:MATTHEW WICK, M.D., PLLC
Entity type:Organization
Organization Name:MATTHEW WICK, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:WICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-672-3252
Mailing Address - Street 1:1441 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3534
Mailing Address - Country:US
Mailing Address - Phone:325-672-3252
Mailing Address - Fax:325-480-9400
Practice Address - Street 1:1441 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601
Practice Address - Country:US
Practice Address - Phone:325-672-3252
Practice Address - Fax:325-480-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5147261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care