Provider Demographics
NPI:1730941352
Name:SPECIALIZED WOUND CARE
Entity type:Organization
Organization Name:SPECIALIZED WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-471-4994
Mailing Address - Street 1:2960 N CIRCLE DR STE 115
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1163
Mailing Address - Country:US
Mailing Address - Phone:719-471-4994
Mailing Address - Fax:719-471-4064
Practice Address - Street 1:2960 N CIRCLE DR STE 115
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1163
Practice Address - Country:US
Practice Address - Phone:719-471-4994
Practice Address - Fax:719-471-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center