Basic Information
| Provider Information | |||||||||
| NPI: | 1538187455 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALT LAKE WOUND CARE AND HYPERBARIC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SALT LAKE WOUND CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3949 S 700 E | ||||||||
| Address2: | SUITE #180 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841072384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012882273 | ||||||||
| FaxNumber: | 8012880211 | ||||||||
| Practice Location | |||||||||
| Address1: | 3949 S 700 E | ||||||||
| Address2: | SUITE #180 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841072384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012882273 | ||||||||
| FaxNumber: | 8012880211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | ED | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8012882273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0011X | 6780757-1204 | UT | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine |
No ID Information.