Provider Demographics
NPI:1922821693
Name:WESTERN SLOPE MOBILE WOUND CARE
Entity type:Organization
Organization Name:WESTERN SLOPE MOBILE WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODSIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-243-5970
Mailing Address - Street 1:2478 PATTERSON RD STE 16
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-3606
Mailing Address - Country:US
Mailing Address - Phone:970-399-9899
Mailing Address - Fax:970-399-9897
Practice Address - Street 1:2478 PATTERSON RD STE 16
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-3606
Practice Address - Country:US
Practice Address - Phone:970-399-9899
Practice Address - Fax:970-399-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty