Provider Demographics
NPI:1992124432
Name:TEXAS FEDERAL WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:TEXAS FEDERAL WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:956-618-4878
Mailing Address - Street 1:2715 W TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3433
Mailing Address - Country:US
Mailing Address - Phone:956-618-4878
Mailing Address - Fax:956-618-4879
Practice Address - Street 1:2715 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3433
Practice Address - Country:US
Practice Address - Phone:956-618-4878
Practice Address - Fax:956-618-4879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207QA0505X, 207QG0300X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH07034Medicare UPIN