Provider Demographics
NPI:1124679907
Name:PRECISION WAVE RECOVERY LP
Entity type:Organization
Organization Name:PRECISION WAVE RECOVERY LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:CEO
Authorized Official - Phone:229-291-7287
Mailing Address - Street 1:7220 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2031
Mailing Address - Country:US
Mailing Address - Phone:303-922-4636
Mailing Address - Fax:303-922-4640
Practice Address - Street 1:7700 MAIN ST STE 365
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4456
Practice Address - Country:US
Practice Address - Phone:832-384-4106
Practice Address - Fax:713-943-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty