=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851836092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOUND CARE OF AMERICA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2016
-----------------------------------------------------
Last Update Date | 12/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5058 CONWAY RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32812-1258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-851-2790
-----------------------------------------------------
Fax | 407-851-2709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5058 CONWAY RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32812-1258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-851-2790
-----------------------------------------------------
Fax | 407-851-2709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PATRICK DANG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 407-401-2690
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME98622
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | LL32912
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | ME128076
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------