Healthcare Provider Details

I. General information

NPI: 1922012608
Provider Name (Legal Business Name): NATIONAL WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112B FIELDSTONE RD
CHAMPAIGN IL
61822-8810
US

IV. Provider business mailing address

3356 BIG PINE TRL STE D
CHAMPAIGN IL
61822-1405
US

V. Phone/Fax

Practice location:
  • Phone: 217-355-2680
  • Fax: 217-355-5538
Mailing address:
  • Phone: 217-355-2680
  • Fax: 217-355-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHNNY LEE PRINCE
Title or Position: PRESIDENT OWNER
Credential:
Phone: 217-355-2680