Healthcare Provider Details

I. General information

NPI: 1326850942
Provider Name (Legal Business Name): AMERICAN WOUND CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1837 S MESA DR # C200
MESA AZ
85210-6246
US

IV. Provider business mailing address

1837 S MESA DR # C200
MESA AZ
85210-6246
US

V. Phone/Fax

Practice location:
  • Phone: 480-912-5456
  • Fax:
Mailing address:
  • Phone: 480-912-5456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATRICK DE JONGH
Title or Position: MANAGING MEMBER
Credential:
Phone: 480-912-5456