Philip R. Wisiackas, M.D., P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

F4703 Issued in TX

Legal business name

PHILIP R. WISIACKAS, M.D., P.A.

Practice address

110 Hill Ave
Coldspring, TX 77331-5406

Phone

(936) 653-4223

Fax

(936) 653-5042

NPI assigned

Aug 11, 2010

Last updated

Apr 7, 2011By 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

Philip Robert Wisiackas, MDNPI 1568454304

Title

Physician

Phone

(936) 653-4223

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Philip Robert Wisiackas, MD

  • Family Medicine Physician
  • Coldspring, TX
  • NPI 1568454304
  Authorized official Same address or phone

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302134400000",
    "number": "1174838411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 HILL AVE",
            "city": "COLDSPRING",
            "state": "TX",
            "postal_code": "773315406",
            "telephone_number": "936-653-4223",
            "fax_number": "936-653-5042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 HILL AVE",
            "city": "COLDSPRING",
            "state": "TX",
            "postal_code": "773315406",
            "telephone_number": "936-653-4223",
            "fax_number": "936-653-5042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP R. WISIACKAS, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-11",
        "last_updated": "2011-04-07",
        "status": "A",
        "authorized_official_last_name": "WISIACKAS",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "936-653-4223",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "F4703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "00FS32",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lori Faye McDowell, BSN, RN, MSN-FNP-C
• Maria Guadalupe Navarro Elias, PA-C
• Next Step Behavioral Houston
• Our House of Hope 2
• Peter S Jerome MD PLLC
• Providence Mission Ministry LLC (Providence Family Care)
• Rayfield Jefferson
• Janet Kristine Sanve, M.ED
• Senior Citizens of San Jacinto County
• Renee Lee Sides, MA, LSSP

• Family Medicine Physician in Coldspring, TX
• Providers in Coldspring, 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 Apr 7, 2011; 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.