Healthcare Provider Details

I. General information

NPI: 1225451057
Provider Name (Legal Business Name): TCMC WOUND CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 PARKSIDE DR
KNOXVILLE TN
37934-1956
US

IV. Provider business mailing address

875 HIGHWAY 321 N SUITE 600-227
LENOIR CITY TN
37771-7397
US

V. Phone/Fax

Practice location:
  • Phone: 865-218-2302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberMD018122
License Number StateTN

VIII. Authorized Official

Name: ROGER MILLWOOD
Title or Position: PRESIDENT
Credential:
Phone: 865-228-4541