Provider Demographics
NPI:1285313155
Name:WOUND CARE SPECIALIST INC
Entity type:Organization
Organization Name:WOUND CARE SPECIALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYEESA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-887-6900
Mailing Address - Street 1:4001 W DEVON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4537
Mailing Address - Country:US
Mailing Address - Phone:773-887-6900
Mailing Address - Fax:
Practice Address - Street 1:4001 W DEVON AVE STE 210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4537
Practice Address - Country:US
Practice Address - Phone:773-887-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory