Complete Wound Care Llc | |
67 Masonic Ave Ste 2400 Wallingford CT 06492-3099 | |
(203) 408-2462 | |
Not Available |
Full Name | Complete Wound Care Llc |
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Speciality | General Practice |
Location | 67 Masonic Ave Ste 2400, Wallingford, Connecticut |
Authorized Official Name and Position | Adrian Wyllie (OWNER/PHYSICIAN) |
Authorized Official Contact | 2034082462 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Complete Wound Care Llc 20 Autumn Ct Cheshire CT 06410-3316 Ph: (203) 408-2462 | Complete Wound Care Llc 67 Masonic Ave Ste 2400 Wallingford CT 06492-3099 Ph: (203) 408-2462 |
NPI Number | 1033801568 |
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Provider Enumeration Date | 05/23/2023 |
Last Update Date | 05/23/2023 |
Medicare PECOS PAC ID | 8729445580 |
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Medicare Enrollment ID | O20230609000583 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033801568 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Adrian Kenneth Wyllie |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1407234685 PECOS PAC ID: 7719291525 Enrollment ID: I20170810001282 |
Provider Name | Heather Lee Eckenrode |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1194242008 PECOS PAC ID: 7012252547 Enrollment ID: I20210405000330 |
Provider Name | Melissa Kay Tuohy |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073392817 PECOS PAC ID: 3678917614 Enrollment ID: I20240219001501 |
Provider Name | Abhinit Drupad Shah |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1801423207 PECOS PAC ID: 7719337922 Enrollment ID: I20240411001063 |
Provider Name | Vadim Kurbatov |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1487035168 PECOS PAC ID: 7012220494 Enrollment ID: I20240920000662 |
Provider Name | Allison Brie Jones |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669243937 PECOS PAC ID: 0244762581 Enrollment ID: I20241011002163 |
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