Provider Demographics
NPI:1316778863
Name:MEDPRO WOUND CARE SERVICES LLC
Entity type:Organization
Organization Name:MEDPRO WOUND CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-488-9839
Mailing Address - Street 1:432 HIGHGATE PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-9440
Mailing Address - Country:US
Mailing Address - Phone:833-796-7770
Mailing Address - Fax:800-504-1362
Practice Address - Street 1:432 HIGHGATE PL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-9440
Practice Address - Country:US
Practice Address - Phone:833-796-7770
Practice Address - Fax:800-504-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty