Individual ProviderDaniel WilsonStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address11937 Us Highway 271, Tyler, TX 75708-3154(903) 877-7200(940) 585-8097PECOS EnrollmentBased on the most recent information from CMS, provider Daniel Wilson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1164262135Provider TypeIndividualFull NameWilson, DanielCredentialDOGenderMaleSole ProprietorNoEnumeration Date5/28/2024Last Updated5/28/2024Contact InformationPractice LocationPractice Address11937 Us Highway 271, Tyler, TX 75708-3154Phone(903) 877-7200FaxUnlisted FaxMailing LocationMailing Address504 Ravenwood Dr, Athens, TX 75751-3124Phone(940) 585-8097FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer