Healthcare Provider Details

I. General information

NPI: 1710789227
Provider Name (Legal Business Name): PREMIER WOUND CARE AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2836 E INDIAN SCHOOL RD STE A8
PHOENIX AZ
85016-6864
US

IV. Provider business mailing address

PO BOX 6610
CHANDLER AZ
85246-6610
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-0056
  • Fax:
Mailing address:
  • Phone: 809-262-2604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RADMAN RAHIMINEJAD
Title or Position: OWNER
Credential:
Phone: 480-926-7800