1497092472 NPI number — NATIONAL TELEWOUND CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497092472 NPI number — NATIONAL TELEWOUND CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL TELEWOUND CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497092472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
374 OSPREY PT
Provider Second Line Business Mailing Address:
APT/SUITE
Provider Business Mailing Address City Name:
STONE MOUNTAIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30087-6163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-371-2204
Provider Business Mailing Address Fax Number:
877-210-5143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1141 HORIZON LN
Provider Second Line Business Practice Location Address:
1416
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35824-1477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-371-2204
Provider Business Practice Location Address Fax Number:
877-210-5143
Provider Enumeration Date:
01/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
678-371-2204

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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