Provider Demographics
NPI:1538266531
Name:ADVANCED WOUND THERAPY PLLC
Entity type:Organization
Organization Name:ADVANCED WOUND THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:STYPKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-438-4670
Mailing Address - Street 1:5 CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-6806
Mailing Address - Country:US
Mailing Address - Phone:903-274-6625
Mailing Address - Fax:830-261-5307
Practice Address - Street 1:1025 GARNER FIELD RD
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4809
Practice Address - Country:US
Practice Address - Phone:903-274-6625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG61225Medicare UPIN