C H WILKINSON PHYSICIAN NETWORK

Provider Demographics

• NPI: 1457382947
• Name: C H WILKINSON PHYSICIAN NETWORK
• Entity type: Organization
• Organization Name: C H WILKINSON PHYSICIAN NETWORK
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: ROBERT
• Authorized Official - Last Name: KARL
• Authorized Official - Phone: 469-282-3514
• Mailing Address - Street 1: 919 HIDDEN RDG
• Mailing Address - Street 2: 6TH FLOOR
• Mailing Address - City: IRVING
• Mailing Address - State: TX
• Mailing Address - Zip Code: 75038-3813
• Mailing Address - Country: US
• Mailing Address - Phone: 469-282-2711
• Mailing Address - Fax: 469-282-4609
• Practice Address - Street 1: 919 HIDDEN RDG
• Practice Address - Street 2: 6TH FLOOR
• Practice Address - City: IRVING
• Practice Address - State: TX
• Practice Address - Zip Code: 75038-3813
• Practice Address - Country: US
• Practice Address - Phone: 469-282-2711
• Practice Address - Fax: 469-282-4609
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-07-05
• Last Update Date: 2020-05-28

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	2084N0400X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Neurology	Group - Multi-Specialty
No	2085R0001X	Allopathic & Osteopathic Physicians	Radiology	Radiation Oncology	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TX	190824601	Medicaid
TX	142445901	Medicaid
TX	0018QH	Other	BCBS
TX	0061ML	Other	BCBS
TX	138967815	Medicaid
TX	142445902	Medicaid
TX	0039PV	Other	BCBS
TX	0051NE	Other	BCBS
TX	0087BR	Other	BCBS
TX	0091BR	Other	BCBS
TX	138967816	Medicaid
TX	0093NL	Other	BCBS
TX	081267905	Medicaid
LA	5CF82	Medicare PIN
TX	00Y357	Medicare PIN
TX	0091BR	Medicare PIN
TX	0061ML	Other	BCBS
TX	0039PV	Other	BCBS
TX	138967816	Medicaid
AR	5F383	Medicare PIN
TX	0051NE	Other	BCBS
TX	142445902	Medicaid
TX	00Y790	Medicare PIN
TX	0087BR	Other	BCBS
TX	142445901	Medicaid