Provider Demographics
NPI:1982299004
Name:NORTHWEST FLORIDA WOUND CARE AND HYPERBARIC CENTER LLC
Entity type:Organization
Organization Name:NORTHWEST FLORIDA WOUND CARE AND HYPERBARIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-885-6939
Mailing Address - Street 1:PO BOX 735911
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-5911
Mailing Address - Country:US
Mailing Address - Phone:972-675-7266
Mailing Address - Fax:972-607-4655
Practice Address - Street 1:11501 HUTCHISON BLVD STE 109
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3747
Practice Address - Country:US
Practice Address - Phone:850-250-0112
Practice Address - Fax:850-250-3589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty