Provider Demographics
NPI:1427854926
Name:ADVANCED WOUND THERAPY - AR, LLC
Entity type:Organization
Organization Name:ADVANCED WOUND THERAPY - AR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER & GNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-592-9020
Mailing Address - Street 1:2488 E 81ST ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4224
Mailing Address - Country:US
Mailing Address - Phone:918-630-0806
Mailing Address - Fax:
Practice Address - Street 1:593 S HORSEBARN RD STE 200
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8798
Practice Address - Country:US
Practice Address - Phone:918-592-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED WOUND THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty