=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881539971
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOUND HEALING CARE SPECIALISTS ID, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2026
-----------------------------------------------------
Last Update Date | 04/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1014 BURRELL AVE
-----------------------------------------------------
City | LEWISTON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83501-5472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-944-0486
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3295 W ELDER ST STE 209
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83705-4772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PETE CARRASCO JR.
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 909-944-0486
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------