Healthcare Provider Details

I. General information

NPI: 1700633070
Provider Name (Legal Business Name): PREFERRED MOBILE WOUND SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 MAGIC MILE ST STE 4
ARLINGTON TX
76011-5108
US

IV. Provider business mailing address

602 MAGIC MILE ST STE 4
ARLINGTON TX
76011-5108
US

V. Phone/Fax

Practice location:
  • Phone: 469-644-6727
  • Fax:
Mailing address:
  • Phone: 469-644-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RICHARD DAVIS
Title or Position: MANAGING PARTNER
Credential:
Phone: 682-248-3380