Healthcare Provider Details

I. General information

NPI: 1811815129
Provider Name (Legal Business Name): WILDWOOD MEDICAL VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16318 MONUMENT ROCK CT
MONUMENT CO
80132-6199
US

IV. Provider business mailing address

16318 MONUMENT ROCK CT
MONUMENT CO
80132-6199
US

V. Phone/Fax

Practice location:
  • Phone: 910-685-0982
  • Fax:
Mailing address:
  • Phone: 910-685-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: REBEKAH LYNN MACASKILL
Title or Position: PHYSICIAN ASSISTANT
Credential: PA
Phone: 910-685-0982