Provider Demographics
NPI:1902653751
Name:PREMIER WOUND CARE SPECIALISTS PA
Entity type:Organization
Organization Name:PREMIER WOUND CARE SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-304-7422
Mailing Address - Street 1:1502 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2902
Mailing Address - Country:US
Mailing Address - Phone:817-304-7422
Mailing Address - Fax:940-301-3903
Practice Address - Street 1:1502 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-2902
Practice Address - Country:US
Practice Address - Phone:817-304-7422
Practice Address - Fax:940-301-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty