Old Mission Wound Care Wisconsin LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

OLD MISSION WOUND CARE WISCONSIN LLC

Practice address

1989 Kroupa Rd
Traverse City, MI 49686-9759

Phone

(231) 260-4622

NPI assigned

Aug 7, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Christopher Paul Mason, DO

Title

Owner

Phone

(231) 260-4622

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724284800000",
    "number": "1124858675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MATLAGE WAY UNIT 31",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774870807",
            "telephone_number": "231-260-4622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1989 KROUPA RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496869759",
            "telephone_number": "231-260-4622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD MISSION WOUND CARE WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-07",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-260-4622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Old Mission Wound Care South Carolina LLC
• Old Mission Wound Care Tennessee PLLC
• Old Mission Wound Care Texas PLLC
• Old Mission Wound Care Virginia PLLC
• Old Mission Wound Care West Virginia, PLLC
• Old Town Psychological Services
• Anthony Wayne Oldham
• Jessi Olivia-Joy
• Ronald Kevin Olm, DPM, FACFAS, C-PED
• Nathan Olsen, N.D.

• Specialist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.