NPIMap

Organization Active NPI

Comprehensive Wound Care

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Phoenix, AZ
National Provider Identifier
1740489251
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X
Legal business name
COMPREHENSIVE WOUND CARE
Practice address
16515 S 40TH St
Suite 139
Phoenix, AZ 85048-0558
Phone
(480) 706-0174
Fax
(480) 706-0117
NPI assigned
Jul 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Dr. Kenneth L Pettit, D.ONPI 1447296298
Title
Owner Physician
Phone
(480) 706-0174

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2083P0011X Primary

Addresses

Primary practice location

16515 S 40TH St
Suite 139
Phoenix, AZ 85048-0558

Mailing address

16515 S 40TH St
Suite 139
Phoenix, AZ 85048-0558
Phone (480) 706-0174

Other identifiers 1

IdentifierTypeStateIssuer
887507MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Comprehensive Wound Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4530 E Muirwood Dr
Ste 108
Phoenix, AZ 85048

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1740489251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16515 S 40TH ST",
            "address_2": "SUITE 139",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850480558",
            "telephone_number": "480-706-0174",
            "fax_number": "480-706-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16515 S 40TH ST",
            "address_2": "SUITE 139",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850480558",
            "telephone_number": "480-706-0174",
            "fax_number": "480-706-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE WOUND CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-13",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER PHYSICIAN",
        "authorized_official_telephone_number": "480-706-0174",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "2083P0011X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "887507",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.