Advanced Wound Therapy Idaho PLLC
Organization Active NPI Family Medicine Physician · Post Falls, ID
NPI 1619863404 · NPPES record last updated Jan 13, 2026
Key facts
- NPI
- 1619863404
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ADVANCED WOUND THERAPY IDAHO PLLC
- Practice address
- 1224 N Idaho St Ste 9
Post Falls, ID 83854-9024 - Phone
- (918) 592-0920
- NPI assigned
- Jun 17, 2025
- Organization subpart
- No
Authorized official
- Name
- Darwin Griffeth, DC
- Title
- Coo
- Phone
- (918) 592-9020
Practitioners 2
-
Matthew L Carmichael, D.O.
-
Thomas Kenton Denmark, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D2332615 | Advanced Wound Therapy-Idaho PPLC | Certificate of waiver | Oct 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260424001699 | ID | Part B Supplier - Clinic/Group Practice | 7719454909 |
Receives reassigned benefits from 2 practitioners Practice locations: Post Falls, ID |
National Provider Directory
Locations
1224 N Idaho St
Ste 9
Post Falls, ID 83854
Phone (918) 592-0920
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1224 N Idaho St Ste 9
Post Falls, ID 83854-9024
Mailing address
2488 E 81St St Ste 2000
Tulsa, OK 74137-4224
Phone (918) 592-9020
Other providers in Post Falls, ID
- Acrs, Inc
- Eve Adams
- Mikayla Adams
- Amber Rebecca Addams
- John T. Ader
- Aes Post Falls
- Ahc Home Care LLC
- Bartimaeus Alan
- Holly Alexander
- Sai Pramod Krishna Alla
All providers in Post Falls, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.