Provider Demographics
NPI:1376240028
Name:MOBILE WOUND CARE LLC
Entity Type:Organization
Organization Name:MOBILE WOUND CARE LLC
Other - Org Name:ON-SITE WOUNDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-216-3747
Mailing Address - Street 1:301 LILAC DR STE 150
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7297
Mailing Address - Country:US
Mailing Address - Phone:405-216-3747
Mailing Address - Fax:405-920-6420
Practice Address - Street 1:301 LILAC DR STE 150
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7297
Practice Address - Country:US
Practice Address - Phone:405-216-3747
Practice Address - Fax:405-920-6420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty