Wisdom Healthcare Clinic N Healthcare Services Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PA04564 Issued in TX

Legal business name

WISDOM HEALTHCARE CLINIC N HEALTHCARE SERVICES INC

Practice address

403 W Main St
Suite B
Lewisville, TX 75057-3757

Phone

(817) 200-6189

Fax

(469) 464-4398

NPI assigned

Jun 3, 2008

Last updated

Jan 16, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael A Badejo, PANPI 1134169048

Title

Director

Phone

(972) 436-1811

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael A Badejo, PHYSICIAN ASSISTANT

  • Medical Physician Assistant
  • Lewisville, TX
  • NPI 1134169048
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263600000000",
    "number": "1013176114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 W MAIN ST",
            "address_2": "SUITE B",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750573757",
            "telephone_number": "817-200-6189",
            "fax_number": "469-464-4398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 W MAIN ST",
            "address_2": "SUITE B",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750573757",
            "telephone_number": "817-200-6189",
            "fax_number": "469-464-4398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISDOM HEALTHCARE CLINIC N HEALTHCARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2010-01-16",
        "status": "A",
        "authorized_official_last_name": "BADEJO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "972-436-1811",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "PA04564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "198899001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1067786",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA04564",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Rene'E Wilson, LMFT
• Malinda Gayle Wilson, LPC
• Cynthia Joan Winkeljohn, P.T.
• De 'Monica Winston
• Ruth K Wirawan, MS, FDN-P, EEM-CP
• Kevin H. Witt
• Ladessea Mornae Woodberry
• Spencer Joel Woodward, DC
• Wookwon Park DDS PLLC (Park Dental Clinic)
• Woori Pharmacy LLC

• Family Medicine Physician in Lewisville, TX
• Providers in Lewisville, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.