Provider Demographics
NPI:1992534846
Name:WOUND CARE MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:WOUND CARE MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTH OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRINGTON
Authorized Official - Middle Name:PHILLIPS
Authorized Official - Last Name:ALTENBERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:737-703-8191
Mailing Address - Street 1:8161 HIGHWAY 100 # 264
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-4213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 DEER PARK DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-3319
Practice Address - Country:US
Practice Address - Phone:737-703-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies