MEDICARE: ARES ADVANCED WOUND CARE PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WW0000X	Wound Care Registered Nurse
2	261QM1300X	Multi-Specialty Clinic/Center
3	363LA2200X	Adult Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942910138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARES ADVANCED WOUND CARE PLLC

Provider Business Mailing Address
First Line	:	5660 W FLAMINGO RD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2312
Country	:	US
Telephone Number	:	702-890-8147
Fax Number	:	702-659-8910

Provider Business Practice Location Address
First Line	:	5660 W FLAMINGO RD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2312
Country	:	US
Telephone Number	:	702-890-8147
Fax Number	:	702-659-8910

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	KENNETH ARES
Credential	:	APRN
Telephone Number	:	702-596-2188

Provider Enumeration Date	:	11/29/2022
Last Update Date	:	01/06/2023

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