Organization
ADVANCED WOUND INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AJ DOYLE (GENERAL MANAGER)
(480) 626-1746
Entity
Organization
Contact information
Practice address
4915 E BASELINE RD STE 104, GILBERT, AZ 85234-2966
(480) 616-0672
(480) 546-5369
Mailing address
DEPT#880392, P.O BOX 29650, PHOENIX, AZ 85038
(480) 616-0016
(480) 626-2690
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079456
—
AZ
Enumeration date
03/09/2020
Last updated
12/20/2023
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