| Dragonfly Advanced Wound Care | |
|
6835 E Southport Rd Ste D Indianapolis IN 46237-9714 | |
| (317) 572-7076 | |
| (586) 204-2483 |
| Full Name | Dragonfly Advanced Wound Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 6835 E Southport Rd Ste D, Indianapolis, Indiana |
| Authorized Official Name and Position | Caleb Wiles (PRACTICE MANAGER) |
| Authorized Official Contact | 3176905706 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dragonfly Advanced Wound Care 6835 E Southport Rd Ste D Indianapolis IN 46237-9714 Ph: (317) 572-7076 | Dragonfly Advanced Wound Care 6835 E Southport Rd Ste D Indianapolis IN 46237-9714 Ph: (317) 572-7076 |
| NPI Number | 1093427700 |
|---|---|
| Provider Enumeration Date | 12/14/2022 |
| Last Update Date | 12/14/2022 |
| Medicare PECOS PAC ID | 9931579166 |
|---|---|
| Medicare Enrollment ID | O20230105000676 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093427700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Crystal D Wiles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831578970 PECOS PAC ID: 3577878263 Enrollment ID: I20150810001606 |
| Provider Name | Emily Marie Mcclure |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497320576 PECOS PAC ID: 9830590694 Enrollment ID: I20210630002202 |
| Provider Name | Jacob Fayiah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093473100 PECOS PAC ID: 1052701760 Enrollment ID: I20211210001273 |
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