DOUGLASS JOHN WACKER (NPI# 1790927192) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790927192 |
| Entity Type | Individual |
| Full Name | DOUGLASS JOHN WACKER |
| Credential | C.P.O. |
| Practice Address |
3900 La Branch St Houston TX 77004-4046 |
| Practice Telephone | 7135243949 |
| Practice Fax Number | 7135243915 |
| Mailing Telephone | 7135243949 |
| Mailing Fax Number | 7135243915 |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2016-11-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 222Z00000X | Orthotist | 85 | TX | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 224P00000X | Prosthetist | 85 | TX | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | PO0012 | 05 |
| Street Address |
3900 LA BRANCH ST |
| City | HOUSTON |
| State | TX |
| Zip Code | 77004-4046 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265488811 | Muilenburg Prosthetics, Inc. | Prosthetist | 3900 La Branch St, Houston, TX 77004 | 2006-05-25 |
| 1295172021 | Amelia Sue Rosetta-warren | Orthotist | 3900 La Branch St, Houston, TX 77004-4046 | 2013-06-03 |
| 1619199619 | Ted B Muilenburg | Prosthetist | 3900 La Branch St, Houston, TX 77004-4046 | 2007-05-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366081622 | University of Houston | Community Health Worker | 4649 Calhoun Rd, Ste 342, Houston, TX 77004 | 2020-01-03 |
| 1205487394 | Sharon B Robinson | Technician | 3405 Drew Apt. #1, Houston, TX 77004 | 2019-09-20 |
| 1386206209 | H-e-b, Lp | Clinical Medical Laboratory | 6055 South Freeway, Houston, TX 77004 | 2019-07-01 |
| 1952886699 | Accucare Medical Clinic Pllc | Clinic/Center | 2918 San Jacinto St Ste 150, Houston, TX 77004 | 2018-09-28 |
| 1922541275 | Rita Assi | Student in an Organized Health Care Education/Training Program | 4407 Austin Street, Houston, TX 77004 | 2016-11-18 |
| 1396291001 | Yoon Jung Park | Nurse Practitioner | 1200 Binz St #1040, Houston, TX 77004 | 2016-09-01 |
| 1962869339 | Elite One Direct | Home Health | 3501 Chenevert, 24, Houston, TX 77004 | 2016-01-15 |
| 1750624391 | Houston Skin Cancer Associates, Pllc | Dermatology | 1401 Binz Street, Suite 200, Houston, TX 77004 | 2013-04-02 |
| 1508109273 | Akwete Riley | Speech-Language Pathologist | 2712 Isabella, Houston, TX 77004 | 2013-04-01 |
| 1831437003 | Lonestar Dental Emergency Care, PC | Dentist | 5445 Almeda Rd, Ste. 300, Houston, TX 77004 | 2013-01-23 |
| Find all providers in zip 77004 | ||||
| Taxonomy Code | 224P00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Prosthetist |
| A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained complete or partial limb loss or absence. Prosthetists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922631043 | Kyera Johnson | Prosthetist | 5619 Aldine Bender Rd Apt 275b, Houston, TX 77032-4506 | 2020-02-17 |
| 1427696145 | M D Prosthetics | Prosthetist | 2000 Crawford St Ste 1122, Houston, TX 77002-9065 | 2019-12-12 |
| 1104314780 | Keisha Davis | Prosthetist | 10350 S Post Oak Rd # 610, Houston, TX 77035-3313 | 2018-04-29 |
| 1447766092 | Delshaveon Masters | Prosthetist | 2802 W Tc Jester Blvd, Apt 1, Houston, TX 77018 | 2017-12-19 |
| 1285062125 | James Beckham | Prosthetist | 16630 Imperial Valley Dr Ste 137, Houston, TX 77060-3410 | 2013-10-30 |
| 1073881348 | Bryan T Sparks | Prosthetist | 8239 Almeda Rd, Houston, TX 77054-4101 | 2011-12-01 |
| 1760660799 | Vaughn Eugene Washington | Prosthetist | 9811 North Fwy, Suite A-108, Houston, TX 77037-1348 | 2008-01-31 |
| 1700973518 | Jon Brent Holmes | Prosthetist | 8998 Kirby Dr, Houston, TX 77054-2830 | 2006-10-05 |
| 1265488811 | Muilenburg Prosthetics, Inc. | Prosthetist | 3900 La Branch St, Houston, TX 77004 | 2006-05-25 |
| 1245220425 | Robert Schiff | Prosthetist | 2525 W. Bellfort, Suite 150, Houston, TX 77054 | 2005-10-27 |
| Find all providers in HOUSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.