Healthcare Provider Details

I. General information

NPI: 1366337610
Provider Name (Legal Business Name): LSA WOUND CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4617 94TH ST
LUBBOCK TX
79424-5015
US

IV. Provider business mailing address

4617 94TH ST
LUBBOCK TX
79424-5015
US

V. Phone/Fax

Practice location:
  • Phone: 512-965-4557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARRY MCINTOSH
Title or Position: BUSINESS MANAGER
Credential:
Phone: 512-965-4557