Provider Demographics
NPI:1588943914
Name:TEXOMA PULMONARY & SLEEP SPECIALIST PA
Entity type:Organization
Organization Name:TEXOMA PULMONARY & SLEEP SPECIALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-818-0473
Mailing Address - Street 1:PO BOX 3049
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-3049
Mailing Address - Country:US
Mailing Address - Phone:903-463-0003
Mailing Address - Fax:903-463-0011
Practice Address - Street 1:101 N US HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1544
Practice Address - Country:US
Practice Address - Phone:903-463-0003
Practice Address - Fax:903-463-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6469207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty