Healthcare Provider Details

I. General information

NPI: 1073499166
Provider Name (Legal Business Name): WOUND CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 E BROADWAY RD STE 102
MESA AZ
85206-1750
US

IV. Provider business mailing address

6424 E BROADWAY RD STE 102
MESA AZ
85206-1750
US

V. Phone/Fax

Practice location:
  • Phone: 931-993-9770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDIE HARRISON
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-204-4593