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Organization
WISE CLINICAL CARE ASSOCIATES
Active
Organization
WISE CLINICAL CARE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN TODD SCOGGINS (CFO)
(940) 626-1228
Entity
Organization
Contact information
Practice address
2202 US HIGHWAY 380 STE 112, BRIDGEPORT, TX 76426-2177
(940) 683-2338
(940) 683-2394
Mailing address
PO BOX 2078, DECATUR, TX 76234-6156
(940) 683-2338
(940) 683-2394
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
261Q00000X
Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0047SH
BCBS
TX
05
—
206106101
—
TX
01
—
206106102
MEDICAID TEXAS HEALTH STEPS
TX
01
—
DP6508
MEDICARE RAILROAD
TX
Enumeration date
12/17/2008
Last updated
01/24/2023
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