Provider Demographics
NPI:1922719095
Name:ADVANCED WOUND THERAPY
Entity Type:Organization
Organization Name:ADVANCED WOUND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:W
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-805-4885
Mailing Address - Street 1:2448 E 81ST ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4315
Mailing Address - Country:US
Mailing Address - Phone:918-592-9020
Mailing Address - Fax:918-779-0219
Practice Address - Street 1:2448 E 81ST ST STE 1500
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4315
Practice Address - Country:US
Practice Address - Phone:918-592-9020
Practice Address - Fax:918-779-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty