=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972481992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MS WOUND CARE EXPERTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2025
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 HIGHLAND COLONY PKWY STE 5203
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-2079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-858-4851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 223 79TH ST
-----------------------------------------------------
City | BURR RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60527-5955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | BRENDA R HASSEBROCK
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 713-858-4851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------