Organization
WILSON C SY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILSON C. SY M.D. (MEDICAL DIRECTOR)
(956) 631-2529
Entity
Organization
Contact information
Practice address
1102 W TRENTON RD, EDINBURG, TX 78539-9105
(956) 631-2529
(956) 631-2933
Mailing address
5111 N 10TH ST # 347, MCALLEN, TX 78504-2835
(956) 631-2529
(956) 631-2933
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
K1085
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00530D
BLUE CROSS BLUE SHIELD TX
TX
05
—
110661901
—
TX
01
—
110661902
MEDICAID CSHCN NUMBER
TX
01
—
117103
CHIPS
TX
Enumeration date
02/08/2007
Last updated
12/02/2023
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