NPIMap

Organization Active NPI

Innovative Wound Pros LLC

  • Surgery Physician
  • Las Vegas, NV
National Provider Identifier
1629724174
Registry record updated Sep 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
INNOVATIVE WOUND PROS LLC
Practice address
153 S Ring Dove Dr
Las Vegas, NV 89144-4351
Phone
(617) 895-7644
NPI assigned
Feb 23, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2022

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

Authorized official

Name
Saju Joseph, MD
Title
Owner
Phone
(617) 895-7644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

153 S Ring Dove Dr
Las Vegas, NV 89144-4351

Mailing address

153 S Ring Dove Dr
Las Vegas, NV 89144-4351
Phone (617) 895-7644

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662422400000",
    "number": "1629724174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 S RING DOVE DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891444351",
            "telephone_number": "617-895-7644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 S RING DOVE DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891444351",
            "telephone_number": "617-895-7644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE WOUND PROS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-23",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A",
        "authorized_official_last_name": "JOSEPH",
        "authorized_official_first_name": "SAJU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-895-7644",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; 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.