Healthcare Provider Details

I. General information

NPI: 1447909171
Provider Name (Legal Business Name): AZ WOUND SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 04/22/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 W THUNDERBIRD RD
GLENDALE AZ
85306-4836
US

IV. Provider business mailing address

5145 W THUNDERBIRD RD
GLENDALE AZ
85306-4836
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-8477
  • Fax:
Mailing address:
  • Phone: 602-978-8477
  • Fax: 602-978-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CYNDI TEETER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 602-978-5000