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General NPI Number Information
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NPI Number | 1093502742
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Entity Type | Organization
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Legal Business Name | IMPACT HEALTH WOUND CARE PLLC
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 323 STATE ST STE 5
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City | AUGUSTA
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State | ME
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Zip | 04330-7149
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Country | US
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Telephone | 404-319-9485
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Fax |
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Provider Business Mailing Address
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Address Line | 240 INDIAN RIVER RD STE C7
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City | ORANGE
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State | CT
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Zip | 06477-3691
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Country | US
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Telephone | 203-497-3861
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSE A VENTURA
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Credential |
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Telephone | 404-319-9485
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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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