Basic Information
| Provider Information | |||||||||
| NPI: | 1982356374 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WIZE HEART SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1352 QUEENS BROOK LN | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761405745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694397544 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Practice Location | |||||||||
| Address1: | 2305 OAK LANE, BUILDING 4A, | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | GRAND PRAIRI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694397544 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2022 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | IGWEGBE | ||||||||
| AuthorizedOfficialFirstName: | CHIBUDIKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | THE OWNER / DIRECTOR OF OPERATION | ||||||||
| AuthorizedOfficialTelephone: | 4694397544 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WIZE HEART SERVICES LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 347C00000X | Y | Transportation Services | Private Vehicle |
No ID Information.