MEDICARE: UTAH WOUND CARE AND HYPERBARIC CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
2	363A00000X	Physician Assistant
3	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12742218-0151	OTHER	UT	UT BUISNESS LICENSE REGISTRATION

General Provider Information

NPI Number	:	1639815483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTAH WOUND CARE AND HYPERBARIC CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 848
Second Line	:
City	:	ROY
State	:	UT
Zip	:	84067-0848
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 E GORDON AVE STE 1
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-2357
Country	:	US
Telephone Number	:	385-786-6100
Fax Number	:	385-786-6101

Authorized Official
Title or Position	:	OWNER
Name	:	MIKE SESSIONS
Credential	:
Telephone Number	:	209-587-9330

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	05/11/2026

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