Provider Demographics
NPI:1306594148
Name:ENHANCED WOUND CARE LLC
Entity type:Organization
Organization Name:ENHANCED WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-231-8724
Mailing Address - Street 1:6440 AVONDALE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73116-6416
Mailing Address - Country:US
Mailing Address - Phone:918-231-8724
Mailing Address - Fax:918-512-4063
Practice Address - Street 1:6440 AVONDALE DR STE 202
Practice Address - Street 2:
Practice Address - City:NICHOLS HILLS
Practice Address - State:OK
Practice Address - Zip Code:73116-6416
Practice Address - Country:US
Practice Address - Phone:918-231-8724
Practice Address - Fax:918-512-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service