Provider Demographics
NPI:1043059298
Name:OLD MISSION MEDICINE WOUND CARE NEW YORK PLLC
Entity type:Organization
Organization Name:OLD MISSION MEDICINE WOUND CARE NEW YORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-260-4622
Mailing Address - Street 1:225 MATLAGE WAY UNIT 31
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-0807
Mailing Address - Country:US
Mailing Address - Phone:231-260-4622
Mailing Address - Fax:
Practice Address - Street 1:1989 KROUPA RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-9759
Practice Address - Country:US
Practice Address - Phone:231-260-4622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty