MEDICARE: AMERICAN WOUND CARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163WW0000X	Wound Care Registered Nurse
2	363L00000X	Nurse Practitioner
3	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1326850942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN WOUND CARE CENTER

Provider Business Mailing Address
First Line	:	1837 S MESA DR # C200
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-6246
Country	:	US
Telephone Number	:	480-912-5456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1837 S MESA DR # C200
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-6246
Country	:	US
Telephone Number	:	480-912-5456
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	PATRICK DE JONGH
Credential	:
Telephone Number	:	480-912-5456

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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Directions to “AMERICAN WOUND CARE CENTER ” Practice Location

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