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Contact Information

WOUND AND MEDICAL OUTREACH CLINIC LLC
12250 BLUE PACIFIC DR
RIVERVIEW, FL33579-1803
 Phone: 813-777-1591
 Fax: 800-351-2611
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
 

Wound Care

163WW0000X
Indicates primary specialty

NPI Profile & details for WOUND AND MEDICAL OUTREACH CLINIC LLC

NPI # 1881229532
LBN Legal business name WOUND AND MEDICAL OUTREACH CLINIC LLC
Authorized official JILL MARSHALL ALLEN - (MGMR)
Entity Organization
Organization subpart 1 No
Enumeration date 03/03/2020
Last updated 11/27/2023 - About 3 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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