| Wound Integrity Utah | |
|
5475 S 500 E Ogden UT 84405-6905 | |
| (801) 479-2111 | |
| Not Available |
| Full Name | Wound Integrity Utah |
|---|---|
| Speciality | Internal Medicine |
| Location | 5475 S 500 E, Ogden, Utah |
| Authorized Official Name and Position | Nora Lopez (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3462399469 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wound Integrity Utah 1 Chisholm Trail Rd Ste 5200 Round Rock TX 78681-5090 Ph: (512) 202-3830 | Wound Integrity Utah 5475 S 500 E Ogden UT 84405-6905 Ph: (801) 479-2111 |
| NPI Number | 1699311209 |
|---|---|
| Provider Enumeration Date | 11/19/2019 |
| Last Update Date | 11/13/2024 |
| Certification Date | 11/13/2024 |
| Medicare PECOS PAC ID | 0042649113 |
|---|---|
| Medicare Enrollment ID | O20200413000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699311209 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 207R00000X | Internal Medicine | () | Primary |
| 207RI0200X | Internal Medicine - Infectious Disease | () | Secondary |
| Provider Name | John Michael Mauric |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891731659 PECOS PAC ID: 4688624117 Enrollment ID: I20170927004284 |
| Provider Name | Danielle Nicole Van Komen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912549072 PECOS PAC ID: 6709211659 Enrollment ID: I20200122003079 |
| Provider Name | Han Schmidly |
|---|---|
| Provider Type | Practitioner - Undersea And Hyperbaric Medicine |
| Provider Identifiers | NPI Number: 1770593436 PECOS PAC ID: 7719923101 Enrollment ID: I20200413000018 |
| Provider Name | Jayson Malufau |
|---|---|
| Provider Type | Practitioner - Undersea And Hyperbaric Medicine |
| Provider Identifiers | NPI Number: 1538554746 PECOS PAC ID: 9032461744 Enrollment ID: I20220110001500 |
| Provider Name | Jeffrey Williams |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1598854432 PECOS PAC ID: 2264495894 Enrollment ID: I20250224000889 |
| Provider Name | Ashley Malcom Huddleston |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568490621 PECOS PAC ID: 5294745121 Enrollment ID: I20260217001257 |
| Provider Name | Rene Sherwin Parungao |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942231667 PECOS PAC ID: 1557364833 Enrollment ID: I20260316003684 |
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