The Wound Store, LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

THE WOUND STORE, LLC

Practice address

10300 N Scottsdale Rd
Suite 11/12
Scottsdale, AZ 85253-1449

Phone

(602) 819-9434

Fax

(866) 453-0085

NPI assigned

Jul 25, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Timothy James Kieborz, MD

Title

Ceo/Owner

Phone

(602) 819-9434

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1619167764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30475",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852750475",
            "telephone_number": "602-819-9434",
            "fax_number": "866-453-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10300 N SCOTTSDALE RD",
            "address_2": "SUITE 11/12",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852531449",
            "telephone_number": "602-819-9434",
            "fax_number": "866-453-0085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WOUND STORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-25",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "KIEBORZ",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "602-819-9434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHARMACY LICENSE",
            "identifier": "Y004798",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.