Organization · NPI-2

Advanced Wound Therapy-Mo, LLC

Family Medicine · Springfield, MO

NPI number1629935044

StatusActive

Last updated in NPPESJan 7, 2026

Details

NPI: 1629935044
Entity type: Organization (NPI-2)
Legal business name: Advanced Wound Therapy-Mo, LLC
Organization subpart: No
Enumeration date: Jan 7, 2026
Certification date: Jan 7, 2026
Last updated: Jan 7, 2026

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207Q00000X	Family Medicine	–	–	Yes

Practice location

1801 W Norton Rd
Springfield, MO 65803-5303

Phone 918-592-9020 · Fax 918-443-3221

Mailing address

2488 E 81st St Ste 2000
Tulsa, OK 74137-4224

Phone 918-592-9020 · Fax 918-443-3221

Authorized official

Scott Dickman
Chief Administrative Officer
9185929020

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