MEDICARE: AMERIWOUND PHYSICIANS MO 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1538046081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERIWOUND PHYSICIANS MO LLC

Provider Business Mailing Address
First Line	:	6150 PARKLAND BLVD STE 225
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-4103
Country	:	US
Telephone Number	:	216-273-9800
Fax Number	:	216-273-9800

Provider Business Practice Location Address
First Line	:	13700 OLD HALLS FERRY RD
Second Line	:
City	:	BLACK JACK
State	:	MO
Zip	:	63033-4109
Country	:	US
Telephone Number	:	314-355-0760
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	SAMSON FIXLER
Credential	:
Telephone Number	:	216-273-9800

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	08/18/2025

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