Provider Demographics
NPI:1619752094
Name:ADVANCED WOUND HEALING LLC
Entity Type:Organization
Organization Name:ADVANCED WOUND HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:NIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-397-2543
Mailing Address - Street 1:6371 RIVERSIDE DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-5446
Mailing Address - Country:US
Mailing Address - Phone:614-222-2222
Mailing Address - Fax:614-930-6168
Practice Address - Street 1:6099 RIVERSIDE DR STE 106
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2004
Practice Address - Country:US
Practice Address - Phone:614-222-2222
Practice Address - Fax:614-930-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty