Provider Demographics
NPI:1619732930
Name:MOBILE WOUND HEALING WA LLC
Entity Type:Organization
Organization Name:MOBILE WOUND HEALING WA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BARGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-209-0019
Mailing Address - Street 1:13140 COUNTRY CLUB DR SW UNIT 204
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-5330
Mailing Address - Country:US
Mailing Address - Phone:253-209-0019
Mailing Address - Fax:
Practice Address - Street 1:13140 COUNTRY CLUB DR SW UNIT 204
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-5330
Practice Address - Country:US
Practice Address - Phone:253-209-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty