Provider Demographics
NPI:1669603296
Name:ADVANCED WOUND AND SURGICAL MANAGEMENT
Entity type:Organization
Organization Name:ADVANCED WOUND AND SURGICAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:RAMAN
Authorized Official - Last Name:DEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-327-2101
Mailing Address - Street 1:2901 SILLECT AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-6371
Mailing Address - Country:US
Mailing Address - Phone:661-327-2101
Mailing Address - Fax:661-327-2554
Practice Address - Street 1:2901 SILLECT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6371
Practice Address - Country:US
Practice Address - Phone:661-327-2101
Practice Address - Fax:661-327-2554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED WOUND AND SURGICAL MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-30
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2086S0122X, 207R00000X, 208200000X, 261QM1300X, 332B00000X
CAA636392083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies