Provider Demographics
NPI:1205376381
Name:ADVANCED VASCULAR AND WOUND ASSOCIATES INC
Entity Type:Organization
Organization Name:ADVANCED VASCULAR AND WOUND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTICIONER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-845-5344
Mailing Address - Street 1:2009 STONE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:SUITE 3006
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-237-2584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty