Provider Demographics
NPI:1063392595
Name:INNOVATIVE WOUND CARE LLC
Entity type:Organization
Organization Name:INNOVATIVE WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-819-6863
Mailing Address - Street 1:3051 TECH DR N STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1001
Mailing Address - Country:US
Mailing Address - Phone:855-819-6863
Mailing Address - Fax:
Practice Address - Street 1:3051 TECH DR N STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1001
Practice Address - Country:US
Practice Address - Phone:833-819-6863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center