Healthcare Provider Details

I. General information

NPI: 1174998702
Provider Name (Legal Business Name): ADEO WOUND SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4790 CAUGHLIN PKWY # 380
RENO NV
89519-0907
US

IV. Provider business mailing address

4790 CAUGHLIN PKWY # 380
RENO NV
89519-0907
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-9798
  • Fax:
Mailing address:
  • Phone: 775-348-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1641
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number7420
License Number StateNV

VIII. Authorized Official

Name: DR. CHARLES P VIRDEN
Title or Position: CEO/FOUNDER
Credential: M.D.
Phone: 775-348-9798