| Prestige Mobile Wound Consultants | |
|
331 Nw 27th Ave Fort Lauderdale FL 33311-8632 | |
| (954) 496-2599 | |
| Not Available |
| Full Name | Prestige Mobile Wound Consultants |
|---|---|
| Speciality | Clinic/Center |
| Location | 331 Nw 27th Ave, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Henry Odazie (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9544400983 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prestige Mobile Wound Consultants 331 Nw 27th Ave Fort Lauderdale FL 33311-8632 Ph: (954) 496-2599 | Prestige Mobile Wound Consultants 331 Nw 27th Ave Fort Lauderdale FL 33311-8632 Ph: (954) 496-2599 |
| NPI Number | 1396493201 |
|---|---|
| Provider Enumeration Date | 03/10/2022 |
| Last Update Date | 06/28/2022 |
| Medicare PECOS PAC ID | 7113314295 |
|---|---|
| Medicare Enrollment ID | O20220419001840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396493201 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Henry Odazie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740880848 PECOS PAC ID: 4688084296 Enrollment ID: I20201111001171 |
| Provider Name | Chinedu O Okeke |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1942663364 PECOS PAC ID: 6901190230 Enrollment ID: I20211108002519 |
| Provider Name | Ca'seem Tyler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912507500 PECOS PAC ID: 2365856879 Enrollment ID: I20220321001626 |
| Provider Name | Mark Gordon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497183404 PECOS PAC ID: 4880050228 Enrollment ID: I20230510000827 |
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