# FIRST SOURCE WOUND CARE

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

## Provider details

- **NPI number:** 1316705361
- **Authorized official:** DR. PETER BROKISH MD (VICE-PRESIDENT)
- **Authorized official phone:** (469) 850-3114

## Contact information

- **Practice address:** 1540 KELLER PKWY STE 108-168, KELLER, TX 76248-3686
- **Practice address phone:** (469) 850-3114
- **Mailing address:** 1540 KELLER PKWY STE 108-168, KELLER, TX 76248-3686
- **Mailing address phone:** (469) 850-3114

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 03/13/2024
- **Last updated:** 03/13/2024