Healthcare Provider Details

I. General information

NPI: 1972269033
Provider Name (Legal Business Name): TOTAL WOUND CARE OF OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NW EXPRESSWAY STE 800
OKLAHOMA CITY OK
73118-1804
US

IV. Provider business mailing address

1900 NW EXPRESSWAY STE 800
OKLAHOMA CITY OK
73118-1804
US

V. Phone/Fax

Practice location:
  • Phone: 405-246-0811
  • Fax: 405-546-5801
Mailing address:
  • Phone: 405-246-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAD BURGESS
Title or Position: CEO
Credential:
Phone: 405-246-0811