Provider Demographics
NPI:1588471809
Name:MOBILE WOUND CARE SPECIALIST LLC
Entity type:Organization
Organization Name:MOBILE WOUND CARE SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-329-6085
Mailing Address - Street 1:13832 N 32ND ST STE C124126G
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5613
Mailing Address - Country:US
Mailing Address - Phone:480-234-3568
Mailing Address - Fax:602-374-3643
Practice Address - Street 1:13832 N 32ND ST STE C124126G
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5613
Practice Address - Country:US
Practice Address - Phone:480-234-3568
Practice Address - Fax:602-374-3643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty