| North Texas Professional Wound Care Associates | |
|
1650 W College St Grapevine TX 76051-3565 | |
| (972) 816-0459 | |
| Not Available |
| Full Name | North Texas Professional Wound Care Associates |
|---|---|
| Speciality | Preventive Medicine |
| Location | 1650 W College St, Grapevine, Texas |
| Authorized Official Name and Position | Maxine A Theriot (PRESIDENT) |
| Authorized Official Contact | 9728160459 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Texas Professional Wound Care Associates 709 West Rusk Street, Suite B, #867 Rockwall TX 75087 Ph: (972) 786-0140 | North Texas Professional Wound Care Associates 1650 W College St Grapevine TX 76051-3565 Ph: (972) 816-0459 |
| NPI Number | 1144262296 |
|---|---|
| Provider Enumeration Date | 06/12/2006 |
| Last Update Date | 07/13/2023 |
| Medicare PECOS PAC ID | 6103842083 |
|---|---|
| Medicare Enrollment ID | O20051020000110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144262296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | J9578 (Texas) | Secondary |
| 2083P0011X | Preventive Medicine - Undersea And Hyperbaric Medicine | J9578 (Texas) | Primary |
| Provider Name | Maxine Theriot |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194874628 PECOS PAC ID: 0648296525 Enrollment ID: I20070517000348 |
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