=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487964904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOUND SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2010
-----------------------------------------------------
Last Update Date | 10/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3807 E BISMARK AVE
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99217-6504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-279-2629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17311 N GOLDEN DR
-----------------------------------------------------
City | COLBERT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99005-9677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-953-1566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JULI SHOGAN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 509-953-1566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 602825451
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------