=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992496343
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION MOBILE WOUND CARE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2023
-----------------------------------------------------
Last Update Date | 05/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 414 SW 140TH TER STE 3300
-----------------------------------------------------
City | NEWBERRY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32669-3363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-281-1593
-----------------------------------------------------
Fax | 352-354-1542
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 414 SW 140TH TER STE 170
-----------------------------------------------------
City | NEWBERRY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32669-5432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-281-1593
-----------------------------------------------------
Fax | 352-354-1542
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, DIRECTOR OF CLINICAL OPERATION
-----------------------------------------------------
Name | SHIRLEY ANN COLLINS
-----------------------------------------------------
Credential | RN,WCC
-----------------------------------------------------
Telephone | 877-281-1593
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------