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NPI Code Detail

MEDICARE: HEALIX WOUND LLC

MEDICARE: HEALIX WOUND 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
1363L00000XNurse Practitioner

General Provider Information

NPI Number : 1528894417
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALIX WOUND LLC
Provider Business Mailing Address
First Line : 3611 PROSPECT AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2703
Country : US
Telephone Number : 216-331-6750
Fax Number : 216-331-6751
Provider Business Practice Location Address
First Line : 3611 PROSPECT AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2703
Country : US
Telephone Number : 216-331-6750
Fax Number : 216-331-6751
Authorized Official
Title or Position : OWNER
Name : SEANA RUTHERFORD
Credential :
Telephone Number : 216-331-6750
Provider Enumeration Date : 09/09/2024
Last Update Date : 09/16/2024

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Directions to “HEALIX WOUND LLC ” Practice Location

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