Healthcare Provider Details

I. General information

NPI: 1265315212
Provider Name (Legal Business Name): SOUTHWEST ARKANSAS WOUND CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7690 E 126TH ST S
BIXBY OK
74008-2680
US

IV. Provider business mailing address

7690 E 126TH ST S
BIXBY OK
74008-2680
US

V. Phone/Fax

Practice location:
  • Phone: 918-600-2701
  • Fax:
Mailing address:
  • Phone: 918-600-2701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA THOMPSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 918-600-2701