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General NPI Number Information
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NPI Number | 1053130542
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Entity Type | Organization
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Legal Business Name | WOUND MANAGEMENT PLLC
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 115 W LAMBERTH RD STE E
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City | SHERMAN
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State | TX
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Zip | 75092-2657
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Country | US
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Telephone | 877-258-6331
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Fax | 718-362-1651
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Provider Business Mailing Address
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Address Line | 612 CORPORATE WAY STE 2M
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City | VALLEY COTTAGE
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State | NY
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Zip | 10989-2027
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Country | US
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Telephone | 718-362-1411
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Fax | 718-362-1651
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN STACKS
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Credential | MD
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Telephone | 903-271-4261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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