Healthcare Provider Details

I. General information

NPI: 1568233898
Provider Name (Legal Business Name): ADVANCED WOUND CARE OF UTAH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

866 S RIDGE RD
CEDAR CITY UT
84720-8232
US

IV. Provider business mailing address

3667 REFLECTION DR
PRESCOTT AZ
86305-7188
US

V. Phone/Fax

Practice location:
  • Phone: 928-530-3230
  • Fax:
Mailing address:
  • Phone: 928-530-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: RON OLSEN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 928-530-3230