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General NPI Number Information
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NPI Number | 1558261222
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Entity Type | Organization
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Legal Business Name | TEXAS REGIONAL ADVANCED WOUND CARE AND LIMB SALVAGE PLLC
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 18881 W DODGE RD STE 400E
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City | ELKHORN
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State | NE
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Zip | 68022-4183
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Country | US
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Telephone | 402-681-4030
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Fax |
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Provider Business Mailing Address
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Address Line | 18881 W DODGE RD STE 400E
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City | ELKHORN
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State | NE
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Zip | 68022-4183
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Country | US
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Telephone | 402-681-4030
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | GABRIEL SULLIVAN
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Credential | NA
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Telephone | 402-681-4030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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