Provider Demographics
NPI:1629800412
Name:TRM ENDOVASCULAR & WOUND CARE SERVICES PLLC
Entity type:Organization
Organization Name:TRM ENDOVASCULAR & WOUND CARE SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-203-8650
Mailing Address - Street 1:7900 AIRWAYS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-4113
Mailing Address - Country:US
Mailing Address - Phone:662-470-7554
Mailing Address - Fax:269-906-2006
Practice Address - Street 1:7900 AIRWAYS BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4113
Practice Address - Country:US
Practice Address - Phone:662-470-7554
Practice Address - Fax:269-906-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS26915OtherSTATE LICENSE