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General NPI Number Information
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NPI Number | 1619863404
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Entity Type | Organization
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Legal Business Name | ADVANCED WOUND THERAPY - IDAHO, PLLC
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1224 N IDAHO ST STE 9
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City | POST FALLS
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State | ID
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Zip | 83854-9024
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Country | US
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Telephone | 918-592-0920
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Fax |
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Provider Business Mailing Address
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Address Line | 2488 E 81ST ST STE 2000
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City | TULSA
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State | OK
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Zip | 74137-4224
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Country | US
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Telephone | 918-592-9020
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DARWIN GRIFFETH
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Credential | DC
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Telephone | 918-592-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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