Provider Demographics
NPI:1992928428
Name:GWENVOLK INFOCUS INC
Entity type:Organization
Organization Name:GWENVOLK INFOCUS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:VOLK
Authorized Official - Suffix:
Authorized Official - Credentials:PA C
Authorized Official - Phone:903-687-2500
Mailing Address - Street 1:390 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:WASKOM
Mailing Address - State:TX
Mailing Address - Zip Code:75692-9113
Mailing Address - Country:US
Mailing Address - Phone:903-687-2500
Mailing Address - Fax:903-687-3510
Practice Address - Street 1:390 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:WASKOM
Practice Address - State:TX
Practice Address - Zip Code:75692-9113
Practice Address - Country:US
Practice Address - Phone:903-687-2500
Practice Address - Fax:903-687-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA0126363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1861484818OtherINDIVIDUAL NPI
TXG87226Medicare UPIN
TX1861484818OtherINDIVIDUAL NPI