Provider Demographics
NPI:1578506754
Name:WOUND CARE CENTER OF HOUSTON INC
Entity type:Organization
Organization Name:WOUND CARE CENTER OF HOUSTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:281-583-4000
Mailing Address - Street 1:830 FM 1960 RD W
Mailing Address - Street 2:SUITE #3
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3416
Mailing Address - Country:US
Mailing Address - Phone:281-583-4000
Mailing Address - Fax:281-583-2540
Practice Address - Street 1:830 FM 1960 RD W
Practice Address - Street 2:SUITE #3
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3416
Practice Address - Country:US
Practice Address - Phone:281-583-4000
Practice Address - Fax:281-583-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03213363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXY32493Medicare UPIN
TX00665YMedicare ID - Type Unspecified