Provider Demographics
NPI:1962802744
Name:TXIM, PLLC
Entity type:Organization
Organization Name:TXIM, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-366-5911
Mailing Address - Street 1:1001 CYPRESS CREEK RD
Mailing Address - Street 2:SUITE #403
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4466
Mailing Address - Country:US
Mailing Address - Phone:512-366-5911
Mailing Address - Fax:512-366-3823
Practice Address - Street 1:1001 CYPRESS CREEK RD
Practice Address - Street 2:SUITE #403
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4466
Practice Address - Country:US
Practice Address - Phone:512-366-5911
Practice Address - Fax:512-366-3823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0084208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty