MR. WILDON MELLINGER ROUSE III NPI 1003873845

Physician Assistant in La Grange, TX

About WILDON ROUSE

Wildon Rouse is a provider in La Grange, TX with more than 19 years of experience. The NPI number assigned to this provider is 1003873845. The practitioner's primary taxonomy code is Physician Assistant (363A00000X). The provider is registered as an individual and their NPI record was last updated 4 years ago. Wildon Rouse is registered with Medicare and accepts claims assignment.

NPI1003873845 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameMR. WILDON MELLINGER ROUSE III
Provider Location Address1253 N VON MINDEN ST LA GRANGE, TX 78945 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address1253 N VON MINDEN ST LA GRANGE, TX 78945 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Medical School NameOTHER
Graduation Year1999
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date04-26-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date12-04-2013 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

MR. WILDON MELLINGER ROUSE III
1253 N VON MINDEN ST
LA GRANGE, TX
ZIP 78945
Phone: (979) 968-8493
Fax: (979) 968-6388
Get Directions

Mailing Address

MR. WILDON MELLINGER ROUSE III
1253 N VON MINDEN ST
LA GRANGE, TX
ZIP 78945
Phone: (979) 968-8493
Fax: (979) 968-6388

Primary Taxonomy

Taxonomy Code363A00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationPhysician Assistant
TypePhysician Assistants & Advanced Practice Nursing Providers
License No.PA02598
License StateTX
Taxonomy DescriptionA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
Q54626MEDICARE UPIN (02)TX
8G0901MEDICARE ID-TYPE UNSPECIFIED (04)TX
875N33OTHER (01)TX
308464202MEDICAID (05)TX
MDF1715TXOTHER (01)TX
P00477542OTHER (01)TX

Map Location


MR. WILDON MELLINGER ROUSE III address is 1253 N VON MINDEN ST LA GRANGE, TX 78945

Other Providers at the same location


The following 9 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1053549709 JENNIFER J EMMEL PA-C
Individual
Physician Assistant1253 N VON MINDEN ST
LA GRANGE, TX 78945
(979) 968-8493
1114088093MCBROOM CLINIC PA
Organization
Family Medicine1253 N VON MINDEN ST
LA GRANGE, TX 78945
(979) 968-8493
1265873251 AMANDA ROSENAUER CFNP
Individual
Nurse Practitioner (Family)1253 N VON MINDEN ST
LA GRANGE, TX 78945
(979) 968-8493
1295877264DR. THOMAS O BORGSTEDTE D.O.
Individual
Family Medicine1253 N VON MINDEN ST
LA GRANGE, TX 78945
(979) 968-8493
1396066213 HOSSAIN ASHRAF DO
Individual
Family Medicine1253 N VON MINDEN ST
LA GRANGE, TX 78945
(979) 968-8493
1407998461DR. WILLIAM M MCBROOM M.D.
Individual
Family Medicine1253 N VON MINDEN ST
LA GRANGE, TX 78945
(979) 968-8493
1649718602 AMANDA G CERNOSEK I CFNP
Individual
Nurse Practitioner (Family)1253 N VON MINDEN ST
LA GRANGE, TX 78945
(979) 968-8493
1770916397MRS. CHELSEA L JECMENEK PA
Individual
Physician Assistant1253 N VON MINDEN ST
LA GRANGE, TX 78945
(979) 968-8493
1780679662DR. WESS JAMES BLACKWELL M.D.
Individual
Family Medicine1253 N VON MINDEN ST
LA GRANGE, TX 78945
(979) 968-8493