# ADVANCED WOUND THERAPY-MO, LLC

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

## Provider details

- **NPI number:** 1629935044
- **Authorized official:** SCOTT DICKMAN (CHIEF ADMINISTRATIVE OFFICER)
- **Authorized official phone:** (918) 592-9020

## Contact information

- **Practice address:** 1801 W NORTON RD, SPRINGFIELD, MO 65803-5303
- **Practice address phone:** (918) 592-9020
- **Practice address fax:** (918) 443-3221
- **Mailing address:** 2488 E 81ST ST STE 2000, TULSA, OK 74137-4224
- **Mailing address phone:** (918) 592-9020
- **Mailing address fax:** (918) 443-3221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/07/2026
- **Last updated:** 01/07/2026