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General NPI Number Information
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NPI Number | 1659199008
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Entity Type | Organization
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Legal Business Name | REVIVE WOUND CARE PLLC
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 28496 RANCH ROAD 12 STE 200 # 105
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620
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Country | US
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Telephone | 951-760-6216
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Fax |
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Provider Business Mailing Address
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Address Line | 13423 BLANCO RD UNIT 3255
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City | SAN ANTONIO
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State | TX
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Zip | 78216-2187
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Country | US
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Telephone | 951-760-6216
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHANNES NEUENDORF
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Credential | DO
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Telephone | 760-809-8654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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