Provider Demographics
NPI:1609760339
Name:ADVANCED WOUND THERAPY-TN LLC
Entity type:Organization
Organization Name:ADVANCED WOUND THERAPY-TN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-592-9020
Mailing Address - Street 1:2488 E 81ST ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4224
Mailing Address - Country:US
Mailing Address - Phone:918-592-9020
Mailing Address - Fax:
Practice Address - Street 1:125 COOL SPRINGS BLVD STE 270
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6574
Practice Address - Country:US
Practice Address - Phone:918-592-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center