| Elite Wound Care, Llc | |
|
8660 E 103rd St Tulsa OK 74133-6982 | |
| (918) 970-6194 | |
| (918) 970-6194 |
| Full Name | Elite Wound Care, Llc |
|---|---|
| Speciality | Orthopaedic Surgery |
| Location | 8660 E 103rd St, Tulsa, Oklahoma |
| Authorized Official Name and Position | Darnell E. Blackmon (OWNER) |
| Authorized Official Contact | 9188300059 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Wound Care, Llc 8660 E 103rd St Tulsa OK 74133-6982 Ph: (918) 830-0059 | Elite Wound Care, Llc 8660 E 103rd St Tulsa OK 74133-6982 Ph: (918) 970-6194 |
| NPI Number | 1396487013 |
|---|---|
| Provider Enumeration Date | 04/12/2022 |
| Last Update Date | 09/24/2022 |
| Medicare PECOS PAC ID | 0547645806 |
|---|---|
| Medicare Enrollment ID | O20220922001866 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396487013 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 207X00000X | Orthopaedic Surgery | (* (Not Available)) | Primary |
| Provider Name | Darnell E Blackmon |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1831150655 PECOS PAC ID: 9436229739 Enrollment ID: I20100730000739 |
| Provider Name | Linda Ellard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265948269 PECOS PAC ID: 6901167287 Enrollment ID: I20180301000613 |
| Provider Name | Tammy Irene Joplin |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1073146312 PECOS PAC ID: 7517361330 Enrollment ID: I20210802000958 |
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