NPIMap

Organization Active NPI

Advanced Mobile Wound Care of Virginia LLC

  • General Practice Physician
  • Charlottesville, VA
National Provider Identifier
1174324610
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
ADVANCED MOBILE WOUND CARE OF VIRGINIA LLC
Doing business as
Advanced Mobile Wound Care of Virginia LLC
Practice address
2109 India Rd
Charlottesville, VA 22901-2886
Phone
(276) 685-1185
NPI assigned
Mar 21, 2025
Last updated
Mar 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

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

Authorized official

Name
Kristin Norman
Title
Authorized Official
Phone
(276) 685-1185

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X Primary

Addresses

Primary practice location

2109 India Rd
Charlottesville, VA 22901-2886

Mailing address

2109 India Rd
Charlottesville, VA 22901-2886
Phone (276) 685-1185

Other names 1

  • Advanced Mobile Wound Care of Virginia LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250422001617 VA Part B Supplier - Clinic/Group Practice 8426573528 Receives reassigned benefits from 12 practitioners
Practice locations: Charlottesville, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1742515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742515200000",
    "number": "1174324610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 INDIA RD",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229012886",
            "telephone_number": "276-685-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 INDIA RD",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229012886",
            "telephone_number": "276-685-1185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MOBILE WOUND CARE OF VIRGINIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-21",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A",
        "authorized_official_last_name": "NORMAN",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "276-685-1185"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Mobile Wound Care of Virginia LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlottesville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.