Provider Demographics
NPI:1770350282
Name:ANGELES WOUND CARE INSTITUTE LLC
Entity type:Organization
Organization Name:ANGELES WOUND CARE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:ANGELES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-749-2282
Mailing Address - Street 1:1239 NE MEDICAL CENTER DR STE 240
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7359
Mailing Address - Country:US
Mailing Address - Phone:541-749-2282
Mailing Address - Fax:541-749-2283
Practice Address - Street 1:1239 NE MEDICAL CENTER DR STE 240
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7359
Practice Address - Country:US
Practice Address - Phone:541-749-2282
Practice Address - Fax:541-749-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty