Provider Demographics
NPI:1093427700
Name:DRAGONFLY ADVANCED WOUND CARE
Entity Type:Organization
Organization Name:DRAGONFLY ADVANCED WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:WILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-690-5706
Mailing Address - Street 1:6835 E SOUTHPORT RD STE D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9714
Mailing Address - Country:US
Mailing Address - Phone:317-572-7076
Mailing Address - Fax:586-204-2483
Practice Address - Street 1:6835 E SOUTHPORT RD STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9714
Practice Address - Country:US
Practice Address - Phone:317-572-7076
Practice Address - Fax:586-204-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center