Healthcare Provider Details

I. General information

NPI: 1437566791
Provider Name (Legal Business Name): WOUND CARE & HYPERBARIC MEDICINE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S DOWNING ST SUITE 260
DENVER CO
80210-5855
US

IV. Provider business mailing address

2555 S DOWNING ST SUITE 260
DENVER CO
80210-5855
US

V. Phone/Fax

Practice location:
  • Phone: 303-765-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number34578
License Number StateCO

VIII. Authorized Official

Name: EDWARD CETARUK
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 303-765-3800