Provider Demographics
NPI:1740024454
Name:IWC OF TEXAS LLC
Entity type:Organization
Organization Name:IWC OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DAPPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-205-2800
Mailing Address - Street 1:315 N SHARY RD STE 1014
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-8235
Mailing Address - Country:US
Mailing Address - Phone:956-205-2800
Mailing Address - Fax:956-205-2427
Practice Address - Street 1:315 N SHARY RD STE 1014
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-8235
Practice Address - Country:US
Practice Address - Phone:956-205-2800
Practice Address - Fax:956-205-2427
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IWC INVESTMENTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty