Provider Demographics
NPI:1417144320
Name:ADVANCED WOUND CARE SYSTEMS OF AMERICA, INC.
Entity Type:Organization
Organization Name:ADVANCED WOUND CARE SYSTEMS OF AMERICA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-671-7749
Mailing Address - Street 1:2520 W 4700 S # 2A
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-1847
Mailing Address - Country:US
Mailing Address - Phone:801-964-2008
Mailing Address - Fax:801-964-2435
Practice Address - Street 1:2520 W 4700 S # 2A
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-1847
Practice Address - Country:US
Practice Address - Phone:801-964-2008
Practice Address - Fax:801-964-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty