# RESTORATION WOUNDCARE MEDICAL GROUP, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255176061
- **Authorized official:** JANA HULL (CHIEF ADMINISTRATIVE OFFICER)
- **Authorized official phone:** (208) 930-1000

## Contact information

- **Practice address:** 2139 N MAIN ST, COEUR D ALENE, ID 83814-5768
- **Practice address phone:** (208) 930-1000
- **Practice address fax:** (877) 376-4040
- **Mailing address:** 2139 N MAIN ST, COEUR D ALENE, ID 83814-5768
- **Mailing address phone:** (208) 930-1000
- **Mailing address fax:** (877) 376-4040

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/25/2024
- **Last updated:** 03/03/2025