| Midwest Wound & Wellness LLC | |
|
555 W Pine St Farmington MO 63640-1439 | |
| (573) 747-1510 | |
| (573) 747-1512 |
| Full Name | Midwest Wound & Wellness LLC |
|---|---|
| Speciality | Clinic/center |
| Location | 555 W Pine St, Farmington, Missouri |
| Authorized Official Name and Position | Kelly M Roberts (OWNER) |
| Authorized Official Contact | 5737471510 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Wound & Wellness LLC 555 W Pine St Farmington MO 63640-1439 Ph: (573) 747-1510 | Midwest Wound & Wellness LLC 555 W Pine St Farmington MO 63640-1439 Ph: (573) 747-1510 |
| NPI Number | 1215467733 |
|---|---|
| Provider Enumeration Date | 06/18/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215467733 | NPI | - | NPPES |
| 1568912129 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| 164W00000X | Licensed Practical Nurse | () | Secondary |
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