Provider Demographics
NPI:1215353727
Name:SOUTHERN WOUND CARE LLC
Entity type:Organization
Organization Name:SOUTHERN WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-546-3148
Mailing Address - Street 1:9055 SW 73RD CT
Mailing Address - Street 2:SUITE 1708
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2931
Mailing Address - Country:US
Mailing Address - Phone:305-546-3148
Mailing Address - Fax:
Practice Address - Street 1:9055 SW 73RD CT
Practice Address - Street 2:SUITE 1708
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2931
Practice Address - Country:US
Practice Address - Phone:305-546-3148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty