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General NPI Number Information
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NPI Number | 1114740115
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Entity Type | Organization
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Legal Business Name | PREMIER WOUND CARE OF THE MIDWEST
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 15325 OLD TOWN DR
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City | PARKVILLE
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State | MO
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Zip | 64152-1547
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Country | US
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Telephone | 573-480-8930
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Fax |
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Provider Business Mailing Address
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Address Line | 15325 OLD TOWN DR
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City | PARKVILLE
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State | MO
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Zip | 64152-1547
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Country | US
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Telephone | 573-480-8930
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA A PICKETT
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Credential | NP
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Telephone | 573-216-8370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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