Provider Demographics
NPI:1891926796
Name:ADVANCED WOUND CARE & HYPERBARICS, PA
Entity Type:Organization
Organization Name:ADVANCED WOUND CARE & HYPERBARICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DRISKILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-202-3638
Mailing Address - Street 1:PO BOX 15453
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-5453
Mailing Address - Country:US
Mailing Address - Phone:501-202-3638
Mailing Address - Fax:501-202-3639
Practice Address - Street 1:3333 SPRINGHILL DR
Practice Address - Street 2:SUITE 2002
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2922
Practice Address - Country:US
Practice Address - Phone:501-202-3638
Practice Address - Fax:501-202-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5G169OtherBLUE CROSS BLUE SHIELD OF ARKANSAS
AR179015002Medicaid
AR179015002Medicaid