Basic Information
| Provider Information | |||||||||
| NPI: | 1700181682 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBILE WOUND SOLUTIONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1916 NW COPPER OAKS CIR | ||||||||
| Address2: | |||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640158300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137088258 | ||||||||
| FaxNumber: | 9137088289 | ||||||||
| Practice Location | |||||||||
| Address1: | 1916 NW COPPER OAKS CIR | ||||||||
| Address2: | |||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640158300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137088258 | ||||||||
| FaxNumber: | 9137088289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2011 | ||||||||
| LastUpdateDate: | 09/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | BLOCK | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9137088258 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R6P79 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.