Organization
WILSON PROSTHETICS CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL THOMAS WILSON CPO-LPO-FAAOP (PRESIDENT)
(281) 403-0107
Entity
Organization
Contact information
Practice address
2711 CARTWRIGHT RD, MISSOURI CITY, TX 77459-2602
(281) 403-0107
(281) 403-0113
Mailing address
2711 CARTWRIGHT RD, MISSOURI CITY, TX 77459-2602
(281) 403-0107
(281) 403-0113
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
101123
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z05085353
—
TX
Enumeration date
12/14/2007
Last updated
06/20/2008
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