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NPI Code Detail

MEDICARE: ELITE WOUND CARE AND MEDICAL SUPPLIES

MEDICARE: ELITE WOUND CARE AND MEDICAL SUPPLIES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BX2000XOxygen Equipment & Supplies (DME)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306358718
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELITE WOUND CARE AND MEDICAL SUPPLIES
Provider Business Mailing Address
First Line : 2498 WASHINGTON RD STE B
Second Line :
City : THOMSON
State : GA
Zip : 30824-6600
Country : US
Telephone Number : 706-595-2200
Fax Number : 706-597-8703
Provider Business Practice Location Address
First Line : 2498 WASHINGTON RD STE B
Second Line :
City : THOMSON
State : GA
Zip : 30824-6600
Country : US
Telephone Number : 706-595-2200
Fax Number : 706-597-8703
Authorized Official
Title or Position : PRESIDENT
Name : DAYNA ANN HICKS
Credential :
Telephone Number : 706-595-2200
Provider Enumeration Date : 10/26/2017
Last Update Date : 04/20/2021

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Directions to “ELITE WOUND CARE AND MEDICAL SUPPLIES ” Practice Location

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