Provider Demographics
NPI:1811303811
Name:CINCINNATI ADVANCED WOUND CARE PHYSICIANS, LLC
Entity type:Organization
Organization Name:CINCINNATI ADVANCED WOUND CARE PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAHEED
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-326-2040
Mailing Address - Street 1:11497 SPRINGFIELD PIKE STE 5
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3551
Mailing Address - Country:US
Mailing Address - Phone:513-326-2040
Mailing Address - Fax:513-771-0241
Practice Address - Street 1:11497 SPRINGFIELD PIKE STE 5
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-3551
Practice Address - Country:US
Practice Address - Phone:513-326-2040
Practice Address - Fax:513-771-0241
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY MEDICAL CLINICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty