| Woundtech Of Utah, Inc. | |
|
517 D St Salt Lake City UT 84103-2831 | |
| (954) 923-7440 | |
| (954) 923-1299 |
| Full Name | Woundtech Of Utah, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 517 D St, Salt Lake City, Utah |
| Authorized Official Name and Position | Minghsun Liu (CEO) |
| Authorized Official Contact | 9549237440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Woundtech Of Utah, Inc. 200 S Park Rd Ste 200 Hollywood FL 33021-8541 Ph: (954) 923-7440 | Woundtech Of Utah, Inc. 517 D St Salt Lake City UT 84103-2831 Ph: (954) 923-7440 |
| NPI Number | 1750922415 |
|---|---|
| Provider Enumeration Date | 10/03/2019 |
| Last Update Date | 05/05/2023 |
| Medicare PECOS PAC ID | 3779919063 |
|---|---|
| Medicare Enrollment ID | O20200205000711 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750922415 | NPI | - | NPPES |
| 11302963-1205 | Other | UT | UTAH MEDICAL BOARD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| Provider Name | Curtis Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962806786 PECOS PAC ID: 3274859012 Enrollment ID: I20150313000586 |
| Provider Name | Amanda A Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164816906 PECOS PAC ID: 9133429301 Enrollment ID: I20151120000775 |
| Provider Name | Minghsun Liu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518096270 PECOS PAC ID: 3577626803 Enrollment ID: I20200313001913 |
| Provider Name | Michelle L Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568075604 PECOS PAC ID: 9537570700 Enrollment ID: I20201118002119 |
| Provider Name | Alisa Porter Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427789064 PECOS PAC ID: 2264806413 Enrollment ID: I20230330000068 |
| Provider Name | Peguy Jacques |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578073250 PECOS PAC ID: 0547626434 Enrollment ID: I20230518002949 |
| Provider Name | Melisa Burns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548033194 PECOS PAC ID: 3173976214 Enrollment ID: I20240125001331 |
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