# MOBILE WOUND CARE SC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1649002734
- **Authorized official:** TYLER STOUT (MANAGER)
- **Authorized official phone:** (337) 315-7927

## Contact information

- **Practice address:** 111 E WISCONSIN AVE STE 1925, MILWAUKEE, WI 53202-4825
- **Practice address phone:** (414) 323-0260
- **Mailing address:** 111 E WISCONSIN AVE STE 1705, MILWAUKEE, WI 53202-4811
- **Mailing address phone:** (414) 323-0260

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WW0000X | Wound Care Registered Nurse | — | NULL | — |
| 163WW0000X | Wound Care Registered Nurse | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/16/2024
- **Last updated:** 12/27/2024