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General NPI Number Information
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NPI Number | 1063236750
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Entity Type | Organization
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Legal Business Name | WOUND LOGIX LLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 120 W RACE AVE STE 9
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City | SEARCY
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State | AR
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Zip | 72143-4237
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Country | US
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Telephone | 501-480-1110
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Fax | 501-480-1005
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Provider Business Mailing Address
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Address Line | 4928 HIGHWAY 367 N
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City | BRADFORD
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State | AR
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Zip | 72020-9714
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Country | US
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Telephone | 250-120-7102
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Fax | 350-150-0502
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MEGAN BALLARD
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Credential |
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Telephone | 501-207-1022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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