Provider Demographics
NPI:1952179251
Name:EXPERT WOUND LLC
Entity Type:Organization
Organization Name:EXPERT WOUND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-669-0025
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-0550
Mailing Address - Country:US
Mailing Address - Phone:801-561-8398
Mailing Address - Fax:801-302-0645
Practice Address - Street 1:406 W SOUTH JORDAN PKWY STE 450
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3946
Practice Address - Country:US
Practice Address - Phone:801-919-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty