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General NPI Number Information
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NPI Number | 1568278208
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Entity Type | Organization
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Legal Business Name | WOUNDOLOGY MSO LLC
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Dates
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Enumeration Date | 12/07/2024
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 615 FERRY ST FL 1
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City | LAFAYETTE
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State | IN
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Zip | 47901-1143
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Country | US
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Telephone | 800-991-7630
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Fax |
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Provider Business Mailing Address
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Address Line | 8924 ARABELLA LN
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City | SEMINOLE
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State | FL
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Zip | 33777-2649
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Country | US
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Telephone | 800-991-7630
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Fax | 800-921-1799
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | PATRICK BENGSTON
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Credential |
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Telephone | 800-991-7630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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