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NPI Code Detail

MEDICARE: HERITAGE WOUND MANAGEMENT SPECIALISTS PLLC

MEDICARE: HERITAGE WOUND MANAGEMENT SPECIALISTS PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1144045659
Entity Type Code : Organization
Provider Name (Legal Business Name) : HERITAGE WOUND MANAGEMENT SPECIALISTS PLLC
Provider Business Mailing Address
First Line : 620 DR CALVIN JONES HWY STE 208
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-3108
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 620 DR CALVIN JONES HWY STE 208
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-3108
Country : US
Telephone Number : 919-761-5678
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ELIZABETH NORTON
Credential : PA
Telephone Number : 919-830-5568
Provider Enumeration Date : 11/19/2024
Last Update Date : 01/26/2025

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