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General NPI Number Information
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NPI Number | 1629935044
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Entity Type | Organization
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Legal Business Name | ADVANCED WOUND THERAPY-MO, LLC
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 1801 W NORTON RD
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City | SPRINGFIELD
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State | MO
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Zip | 65803-5303
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Country | US
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Telephone | 918-592-9020
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Fax | 918-443-3221
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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 | 918-443-3221
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | SCOTT DICKMAN
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Credential |
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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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