NPIMap

Organization Active NPI

Wise County Medical & Surgical Association

  • Family Medicine Physician
  • Bridgeport, TX
National Provider Identifier
1497770390
Registry record updated Jul 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WISE COUNTY MEDICAL & SURGICAL ASSOCIATION
Practice address
1306 13TH St
Bridgeport, TX 76426-2454
Phone
(940) 627-7443
Fax
(940) 627-7597
NPI assigned
Jul 12, 2006
Last updated
Jul 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2010

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

Authorized official

Name
Kala C Walsh
Title
Administrator
Phone
(940) 627-7829

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Body Imaging Physician 2085B0100X NU
Surgery Physician 208600000X NU

Addresses

Primary practice location

1306 13TH St
Bridgeport, TX 76426-2454

Mailing address

1306 13TH St
Bridgeport, TX 76426-2454
Phone (940) 627-7443

Other identifiers 2

IdentifierTypeStateIssuer
CD5800OtherTXRAILROAD
092162901MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Three Rivers2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278547200000",
    "number": "1497770390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 13TH ST",
            "city": "BRIDGEPORT",
            "state": "TX",
            "postal_code": "764262454",
            "telephone_number": "940-627-7443",
            "fax_number": "940-627-7597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 13TH ST",
            "city": "BRIDGEPORT",
            "state": "TX",
            "postal_code": "764262454",
            "telephone_number": "940-627-7443",
            "fax_number": "940-627-7597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE COUNTY MEDICAL & SURGICAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2010-07-08",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "KALA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "940-627-7829"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "CD5800",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092162901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.