=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467678367
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED WOUND CONCEPTS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 09/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23366 COMMERCE PARK SUITE 208
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-595-0940
-----------------------------------------------------
Fax | 877-454-7463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23366 COMMERCE PARK SUITE 208
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-595-0940
-----------------------------------------------------
Fax | 877-454-7463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ADAM J POLLACK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-595-0940
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 061-18015-4
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------