Healthcare Provider Details

I. General information

NPI: 1376124461
Provider Name (Legal Business Name): WOUND CARE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22742 MIDLAND DR
SHAWNEE KS
66226-3553
US

IV. Provider business mailing address

22742 MIDLAND DR
SHAWNEE KS
66226-3553
US

V. Phone/Fax

Practice location:
  • Phone: 913-620-2377
  • Fax:
Mailing address:
  • Phone: 913-620-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW THOMAS GIANFORTE
Title or Position: DIRECTOR
Credential: DC
Phone: 913-620-2377