NPIMap

Organization Active NPI

Wound and Medical Outreach Clinic LLC

  • Nurse Practitioner
  • Riverview, FL
National Provider Identifier
1881229532
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
WOUND AND MEDICAL OUTREACH CLINIC LLC
Practice address
12250 Blue Pacific Dr
Riverview, FL 33579-1803
Phone
(813) 777-1591
Fax
(800) 351-2611
NPI assigned
Mar 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Jill M Marshall AllenNPI 1205877560
Title
MGMR
Phone
(813) 777-1591

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WW0000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

12250 Blue Pacific Dr
Riverview, FL 33579-1803

Mailing address

12250 Blue Pacific Dr
Riverview, FL 33579-1803

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL www.wmoclinic.com Other
Direct Messaging Address Administrator@womclinic.com Direct

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: administrator@womclinic.com

Practitioners & affiliated clinicians

Practitioners 1

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": "1583193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1881229532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12250 BLUE PACIFIC DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335791803",
            "fax_number": "800-351-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12250 BLUE PACIFIC DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335791803",
            "telephone_number": "813-777-1591",
            "fax_number": "800-351-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOUND AND MEDICAL OUTREACH CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-03",
        "last_updated": "2023-11-27",
        "certification_date": "2020-08-06",
        "status": "A",
        "authorized_official_last_name": "MARSHALL ALLEN",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MGMR",
        "authorized_official_telephone_number": "813-777-1591"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.wmoclinic.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Information and Contact",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "website",
            "address_1": "12250 Blue Pacific Dr",
            "city": "Riverview",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335791803",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Administrator@womclinic.com",
            "affiliation": "Y",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "webmail",
            "address_1": "12250 Blue Pacific Dr",
            "city": "Riverview",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335791803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Riverview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.