Provider Demographics
NPI:1770805640
Name:TEXAS ADVANCED WOUND CARE, PLLC
Entity type:Organization
Organization Name:TEXAS ADVANCED WOUND CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:THI
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-729-9912
Mailing Address - Street 1:3308 PRESTON RD
Mailing Address - Street 2:SUITE 350, PMB 133
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 W 15TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5841
Practice Address - Country:US
Practice Address - Phone:214-473-7671
Practice Address - Fax:214-473-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB109820OtherPTAN