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General NPI Number Information
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NPI Number | 1124037114
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Entity Type | Organization
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Legal Business Name | LOUISVILLE WOUND CARE ASSOCIATES PSC
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 1 AUDUBON PLAZA DR
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City | LOUISVILLE
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State | KY
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Zip | 40217
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Country | US
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Telephone | 502-777-9961
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Fax | 502-379-8791
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Provider Business Mailing Address
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Address Line | 2100 GARDINER LN STE 207
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City | LOUISVILLE
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State | KY
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Zip | 40205-2948
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Country | US
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Telephone | 502-777-9961
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Fax | 502-379-8791
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Authorized Official
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Title or Position | PRESIDENT
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Name | RODNEY D MCMILLIN
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Credential | MD
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Telephone | 502-777-9961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3003616
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 23946
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 18435
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License Number State | KY
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