Look up the most recent NPI and PECOS records

Randall Kevin Wolf

Thoracic Surgery (Cardiothoracic Vascular Surgery)

Allopathic & Osteopathic Physicians

6550 Fannin St Ste 1401, Houston, TX 77030

PECOS Enrollment

This provider is enrolled in PECOS as RANDALL WOLF.

Based on the most recent information from CMS, provider Randall Kevin Wolf is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1851369417
Provider Type
Individual
Full Name
Wolf, Randall Kevin
Title
Prof.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
3/9/2006
Last Updated
3/4/2019

Contact Information

Practice Location

6550 Fannin St Ste 1401, Houston, TX 77030

(713) 441-5200

Unlisted Fax

Mailing Location

6550 Fannin St Ste 1401, Houston, TX 77030-2738

(713) 441-5200

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208G00000X Primary	Description Thoracic Surgery (Cardiothoracic Vascular Surgery) Allopathic & Osteopathic Physicians	License Q3312 Texas
Code 208G00000X	Description Thoracic Surgery (Cardiothoracic Vascular Surgery) Allopathic & Osteopathic Physicians	License 01029011A Indiana
Code 208G00000X	Description Thoracic Surgery (Cardiothoracic Vascular Surgery) Allopathic & Osteopathic Physicians	License 35-051891 Ohio

Provider Identifiers

ID	Description	Issuer
ID P01214586	Description Other	Issuer RR MEDICARE PTAN Indiana
ID 345451403	Description Medicaid	Issuer Unlisted Texas
ID 0723506	Description Medicaid	Issuer Unlisted Ohio
ID 100093980	Description Medicaid	Issuer Unlisted Indiana
ID P01080757	Description Other	Issuer RAILROAD PTAN Indiana
ID 64862964	Description Medicaid	Issuer Unlisted Kentucky

Randall Kevin Wolf

PECOS Enrollment

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