Provider Demographics
NPI:1700148095
Name:WORDSWORTH
Entity Type:Organization
Organization Name:WORDSWORTH
Other - Org Name:WORDSWORTH SGD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-842-9653
Mailing Address - Street 1:1901 E CESAR CHAVEZ ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-4501
Mailing Address - Country:US
Mailing Address - Phone:512-842-4656
Mailing Address - Fax:512-477-1523
Practice Address - Street 1:1901 E CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4501
Practice Address - Country:US
Practice Address - Phone:512-842-4656
Practice Address - Fax:512-477-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32045121798OtherTEXAS STATE COMPTROLLER