=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902653751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER WOUND CARE SPECIALISTS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2024
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 MEDICAL PKWY STE 304
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-7843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-909-9772
-----------------------------------------------------
Fax | 972-767-4826
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 MEDICAL PKWY STE 304
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-7843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-909-9772
-----------------------------------------------------
Fax | 972-767-4826
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | LEAH DILL
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 337-315-7927
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------