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General NPI Number Information
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NPI Number | 1548002942
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Entity Type | Organization
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Legal Business Name | ADVANCED WOUNDCARE SPECIALISTS LLC
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 223 FAIRBURN AVE SUITE A
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City | BENTON
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State | LA
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Zip | 71006
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Country | US
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Telephone | 318-229-5055
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Fax |
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Provider Business Mailing Address
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Address Line | 104 HIDDEN PATH DR
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City | PINEVILLE
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State | LA
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Zip | 71360-2202
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Country | US
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Telephone | 318-229-5055
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MICHAEL J HEBERT
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Credential | PA
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Telephone | 318-229-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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