# INNOVATIONS WOUND MANAGEMENT, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083857049
- **Authorized official:** MS. MOIRA HAYES MHA, RRT, CHT (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (713) 301-5707

## Contact information

- **Practice address:** 1234 WAGNER ST, HOUSTON, TX 77007-3719
- **Practice address phone:** (713) 868-3301
- **Practice address fax:** (713) 868-4817
- **Mailing address:** 1234 WAGNER ST, HOUSTON, TX 77007-3719
- **Mailing address phone:** (713) 868-3301
- **Mailing address fax:** (713) 868-4817

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | E8768 | TX | — |
| 208D00000X | General Practice Physician | M1782 | TX | — |
| 208D00000X | General Practice Physician | N6545 | TX | Yes |

## Other

- **Enumeration date:** 04/07/2009
- **Last updated:** 10/27/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0A4031 | PTAN | TX |
| 01 | — | 0A4645 | PTAN | TX |
| 01 | — | 0A5999 | PTAN | TX |
| 05 | — | 2083529-01 | — | TX |
| 01 | — | TXB101103 | PTAN | TX |