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General NPI Number Information
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NPI Number | 1568233898
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Entity Type | Organization
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Legal Business Name | ADVANCED WOUND CARE OF UTAH PLLC
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 13836 S GLEN LAUREL CIR
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City | RIVERTON
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State | UT
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Zip | 84065-2362
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Country | US
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Telephone | 928-530-3230
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10634
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City | PRESCOTT
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State | AZ
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Zip | 86304-0634
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | RON OLSEN
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Credential |
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Telephone | 928-530-3230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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