Provider Demographics
NPI:1093502742
Name:IMPACT HEALTH WOUND CARE PLLC
Entity type:Organization
Organization Name:IMPACT HEALTH WOUND CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VENTURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-200-5907
Mailing Address - Street 1:240 INDIAN RIVER RD STE C7
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3691
Mailing Address - Country:US
Mailing Address - Phone:203-497-3861
Mailing Address - Fax:
Practice Address - Street 1:323 STATE ST STE 5
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7149
Practice Address - Country:US
Practice Address - Phone:207-370-6470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty