Healthcare Provider Details

I. General information

NPI: 1346009040
Provider Name (Legal Business Name): ENCORE WOUND CARE - KENTUCKY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 THUNDERSTICK DR STE 300
LEXINGTON KY
40505-4877
US

IV. Provider business mailing address

12301 RIDGE RD
NORTH ROYALTON OH
44133-3744
US

V. Phone/Fax

Practice location:
  • Phone: 440-652-8748
  • Fax: 440-582-3171
Mailing address:
  • Phone: 609-703-5097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW LEGOWSKI
Title or Position: OPERATIONS
Credential:
Phone: 609-703-5097