Organization Active NPI

Wichita Falls Gastroenterology Associates

  • Gastroenterology Physician
  • Wichita Falls, TX
National Provider Identifier
1265489298
Registry record updated Oct 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
WICHITA FALLS GASTROENTEROLOGY ASSOCIATES
Practice address
1104 Brook Ave
Wichita Falls, TX 76301-5049
Phone
(940) 687-6870
Fax
(940) 687-6871
NPI assigned
May 27, 2006
Last updated
Oct 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2021

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

Authorized official

Name
Louis Wilson, M.D.NPI 1477516938
Title
Registered Agent
Phone
(940) 687-6870

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

1104 Brook Ave
Wichita Falls, TX 76301-5049

Mailing address

1104 Brook Ave
Wichita Falls, TX 76301-5049
Phone (940) 687-6870

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060509000864 TX Part B Supplier - Clinic/Group Practice 4183635899 Receives reassigned benefits from 11 practitioners
Practice locations: Wichita Falls, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1056376Wichita Falls Gastroenterology Associates,LLP1104 Brook Avenue, Wichita Falls, TX 76301Certificate of waiverJul 13, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635292800000",
    "number": "1265489298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 BROOK AVE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763015049",
            "telephone_number": "940-687-6870",
            "fax_number": "940-687-6871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 BROOK AVE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763015049",
            "telephone_number": "940-687-6870",
            "fax_number": "940-687-6871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICHITA FALLS GASTROENTEROLOGY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_title_or_position": "REGISTERED AGENT",
        "authorized_official_telephone_number": "940-687-6870",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.