Healthcare Provider Details

I. General information

NPI: 1063236750
Provider Name (Legal Business Name): WOUND LOGIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W RACE AVE STE 9
SEARCY AR
72143-4237
US

IV. Provider business mailing address

4928 HIGHWAY 367 N
BRADFORD AR
72020-9714
US

V. Phone/Fax

Practice location:
  • Phone: 501-480-1110
  • Fax: 501-480-1005
Mailing address:
  • Phone: 250-120-7102
  • Fax: 350-150-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MEGAN BALLARD
Title or Position: GENERAL MANAGER
Credential:
Phone: 501-207-1022