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Organization
WISE COUNTY MEDICAL & SURGICAL ASSOCIATION
Active
Organization
WISE COUNTY MEDICAL & SURGICAL ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KALA C WALSH (ADMINISTRATOR)
(940) 627-7829
Entity
Organization
Contact information
Practice address
1306 13TH ST, BRIDGEPORT, TX 76426-2454
(940) 627-7443
(940) 627-7597
Mailing address
1306 13TH ST, BRIDGEPORT, TX 76426-2454
(940) 627-7443
(940) 627-7597
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
2085B0100X
Body Imaging Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092162901
—
TX
01
—
CD5800
RAILROAD
TX
Enumeration date
07/12/2006
Last updated
07/08/2010
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