Healthcare Provider Details

I. General information

NPI: 1740084706
Provider Name (Legal Business Name): ADVANCED WOUND TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5795 S ELM PL
BROKEN ARROW OK
74011-4893
US

IV. Provider business mailing address

2488 E 81ST ST STE 2000
TULSA OK
74137-4224
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-9020
  • Fax:
Mailing address:
  • Phone: 918-592-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DARWIN GRIFFETH
Title or Position: COO
Credential: DC
Phone: 918-592-9020