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General NPI Number Information
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NPI Number | 1164231940
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Entity Type | Organization
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Legal Business Name | FLORIDA WOUND CARE ASSOCIATES LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 1399 JENKS AVE UNIT H
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City | PANAMA CITY
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State | FL
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Zip | 32401-2596
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Country | US
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Telephone | 850-866-6427
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Fax |
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Provider Business Mailing Address
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Address Line | 233 W 14TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32401-2205
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Country | US
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Telephone | 850-890-1407
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MICHAEL MADEWELL
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Credential |
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Telephone | 850-890-1407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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