1710707930 NPI number — ENHANCED WOUND CARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710707930 NPI number — ENHANCED WOUND CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENHANCED WOUND CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710707930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6440 AVONDALE DR STE 200-20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NICHOLS HILLS
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73116-6421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-424-3068
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64098-1154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-914-7296
Provider Business Practice Location Address Fax Number:
800-856-8427
Provider Enumeration Date:
10/14/2024

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLEY
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
913-914-7296

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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