Healthcare Provider Details

I. General information

NPI: 1386899946
Provider Name (Legal Business Name): WOUND CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR SUITE 110
SANTA FE NM
87505-7670
US

IV. Provider business mailing address

PO BOX 20490
MESA AZ
85277-0490
US

V. Phone/Fax

Practice location:
  • Phone: 480-985-1093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MARC A STESS
Title or Position: PRESIDENT
Credential: DPM
Phone: 505-670-6853