Healthcare Provider Details

I. General information

NPI: 1265736409
Provider Name (Legal Business Name): WOUND CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

126 SOUTHARM DR
SAINT LOUIS MO
63122-4658
US

V. Phone/Fax

Practice location:
  • Phone: 314-518-0365
  • Fax: 314-698-2838
Mailing address:
  • Phone: 314-518-0365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29011
License Number StateMO

VIII. Authorized Official

Name: DR. JOHN E. CODD
Title or Position: PRESIDENT
Credential: M.D,
Phone: 314-518-0365