MEDICARE: ADVANCED WOUND CARE OF ARIZONA PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1720839665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED WOUND CARE OF ARIZONA PLLC

Provider Business Mailing Address
First Line	:	PO BOX 10634
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86304-0634
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3667 REFLECTION DR
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-7188
Country	:	US
Telephone Number	:	928-530-3230
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	RON OLSEN
Credential	:
Telephone Number	:	928-530-3230

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	02/12/2026

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