Organization Active NPI

Wound Care Center of Texas, PLLC

Doing business as Third River Health

  • Internal Medicine Physician
  • College Station, TX
National Provider Identifier
1710780234
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WOUND CARE CENTER OF TEXAS, PLLC
Doing business as
Third River Health
Practice address
1512 Holleman Dr
College Station, TX 77840-3297
Phone
(979) 426-4325
Fax
(979) 810-0191
NPI assigned
Mar 31, 2025
Last updated
Jul 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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

Authorized official

Name
Johnny Myers, MD
Title
Authorized Official
Phone
(678) 642-4894

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU
Internal Medicine Physician 207R00000X NU Primary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

1512 Holleman Dr
College Station, TX 77840-3297

Mailing address

PO Box 10525
College Station, TX 77842-0525
Phone (979) 426-4325

Other names 1

  • Third River Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250507001728 TX Part B Supplier - Clinic/Group Practice 1850818451 Receives reassigned benefits from 5 practitioners
Practice locations: College Station, TX; Bryan, 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
45D2325197Wound Care Center of Texas PLLC1512 Holleman Dr., College Station, TX 77840Certificate of waiverJun 8, 2027

National Provider Directory

National Provider Directory

Locations

1600 Joseph Dr
#2000
Bryan, TX 77802

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1743379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752019200000",
    "number": "1710780234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10525",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778420525",
            "telephone_number": "979-426-4325",
            "fax_number": "979-810-0191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 HOLLEMAN DR",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778403297",
            "telephone_number": "979-426-4325",
            "fax_number": "979-810-0191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOUND CARE CENTER OF TEXAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-31",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "678-642-4894",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Third River Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Third River Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in College Station, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; 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.