Basic Information
| Provider Information | |||||||||
| NPI: | 1285652156 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | C H WILKINSON PHYSICIAN NETWORK | ||||||||
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| OtherOrganizationName: | CHRISTUS MEDICAL GROUP MARKSVILLE FAMILYCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 919 HIDDEN RDG | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750383813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4682822711 | ||||||||
| FaxNumber: | 4692820996 | ||||||||
| Practice Location | |||||||||
| Address1: | 5541 HIGHWAY 1 | ||||||||
| Address2: | |||||||||
| City: | MARKSVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713512650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182407240 | ||||||||
| FaxNumber: | 3182407118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 03/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | PLANTES | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4692822613 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.