MEDICARE: FRESH FEEL WOUND CARE LLC

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
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1154294668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESH FEEL WOUND CARE LLC

Provider Business Mailing Address
First Line	:	1809 BACH AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3403
Country	:	US
Telephone Number	:	765-230-7260
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 BACH AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3403
Country	:	US
Telephone Number	:	765-230-7260
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN AND OWNER
Name	:	JACOB JACKSON
Credential	:	DO
Telephone Number	:	765-230-7260

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	09/29/2025

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Directions to “FRESH FEEL WOUND CARE LLC ” Practice Location

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