Healthcare Provider Details

I. General information

NPI: 1649215583
Provider Name (Legal Business Name): NORTHEAST SURGICAL WOUND CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 ROCKSIDE WOODS BLVD SUITE 425
INDEPENDENCE OH
44131-2366
US

IV. Provider business mailing address

6100 ROCKSIDE WOODS BLVD SUITE 425
INDEPENDENCE OH
44131-2366
US

V. Phone/Fax

Practice location:
  • Phone: 216-643-2780
  • Fax: 216-524-0111
Mailing address:
  • Phone: 216-643-2780
  • Fax: 216-524-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA AVSEC
Title or Position: PRACTICE MANAGER
Credential:
Phone: 216-643-2780