Healthcare Provider Details

I. General information

NPI: 1659965457
Provider Name (Legal Business Name): OHIO WOUND CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 RIDGE RD
NORTH ROYALTON OH
44133-3744
US

IV. Provider business mailing address

5741 SHIELDS RD STE B
CANFIELD OH
44406-9814
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRACY WIMBERG JR.
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 609-517-2526