Healthcare Provider Details

I. General information

NPI: 1801841804
Provider Name (Legal Business Name): PROFESSIONAL WOUND CARE SERVICES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4499 MEDICAL DR SUB-LEVEL 2
SAN ANTONIO TX
78229-3735
US

IV. Provider business mailing address

PO BOX 1814
SAN ANTONIO TX
78296-1814
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-4325
  • Fax: 210-575-4498
Mailing address:
  • Phone: 210-558-6288
  • Fax: 210-558-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES MARTIN SMITH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-575-4334