Healthcare Provider Details

I. General information

NPI: 1669171997
Provider Name (Legal Business Name): MOBILE WOUND SPECIALISTS NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 OLDE WORTHINGTON RD STE 200
WESTERVILLE OH
43082-9127
US

IV. Provider business mailing address

4577 N NOB HILL RD STE 212
SUNRISE FL
33351-4715
US

V. Phone/Fax

Practice location:
  • Phone: 954-821-7576
  • Fax: 954-634-6444
Mailing address:
  • Phone: 954-821-7576
  • Fax: 954-634-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM H TUSHINSKI
Title or Position: MANAGER
Credential:
Phone: 548-217-5769