MEDICARE: SOUTHWEST CENTRAL WOUND CARE CLINIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LA2100X	Acute Care Nurse Practitioner
2	363LA2200X	Adult Health Nurse Practitioner
3	363LF0000X	Family Nurse Practitioner
4	363L00000X	Nurse Practitioner
5	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1356153845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST CENTRAL WOUND CARE CLINIC PLLC

Provider Business Mailing Address
First Line	:	1910 PACIFIC AVE STE 8045
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-4523
Country	:	US
Telephone Number	:	469-574-7757
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 PACIFIC AVE STE 8045
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-4523
Country	:	US
Telephone Number	:	469-574-7757
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MURTAZA SHAKIR
Credential	:
Telephone Number	:	630-538-7009

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	04/10/2026

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