MEDICARE: CHAMPION WOUND CARE PC

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
1	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1669219994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPION WOUND CARE PC

Provider Business Mailing Address
First Line	:	11230 EMORY OAK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6123
Country	:	US
Telephone Number	:	210-883-7008
Fax Number	:

Provider Business Practice Location Address
First Line	:	11230 EMORY OAK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6123
Country	:	US
Telephone Number	:	210-883-7008
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JON JUHASZ
Credential	:	MD
Telephone Number	:	210-883-7008

Provider Enumeration Date	:	07/12/2024
Last Update Date	:	12/01/2025

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