MEDICARE: TOTAL WOUND CARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1477406965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL WOUND CARE, LLC

Provider Business Mailing Address
First Line	:	1900 NW EXPRESSWAY STE 800
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-1804
Country	:	US
Telephone Number	:	405-246-0811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 NW EXPRESSWAY STE 800
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-1804
Country	:	US
Telephone Number	:	405-246-0811
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	CHRISTINA JACKSON
Credential	:
Telephone Number	:	405-246-0811

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	03/12/2026

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