Provider Demographics
NPI:1063236750
Name:WOUND LOGIX LLC
Entity type:Organization
Organization Name:WOUND LOGIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-207-1022
Mailing Address - Street 1:4928 HIGHWAY 367 N
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:AR
Mailing Address - Zip Code:72020-9714
Mailing Address - Country:US
Mailing Address - Phone:250-120-7102
Mailing Address - Fax:350-150-0502
Practice Address - Street 1:120 W RACE AVE STE 9
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4237
Practice Address - Country:US
Practice Address - Phone:501-480-1110
Practice Address - Fax:501-480-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty