Provider Demographics
NPI:1801808571
Name:C H WILKINSON PHYSICIAN NETWORK
Entity type:Organization
Organization Name:C H WILKINSON PHYSICIAN NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PLANTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-282-2613
Mailing Address - Street 1:PO BOX 848565
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8565
Mailing Address - Country:US
Mailing Address - Phone:469-282-2713
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
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1098809Medicaid
LA5CU95Medicare PIN
LA1098809Medicaid