Healthcare Provider Details

I. General information

NPI: 1225901903
Provider Name (Legal Business Name): MOBILEHEALTH WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HILL CREEK RD
CENTERVILLE MA
02632-3365
US

IV. Provider business mailing address

16 HILL CREEK RD
CENTERVILLE MA
02632-3365
US

V. Phone/Fax

Practice location:
  • Phone: 508-292-4270
  • Fax:
Mailing address:
  • Phone: 508-292-4270
  • 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 Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA BOWEN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 615-504-1984