MEDICARE: WOUND CARE CENTERS OF FLORIDA LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1528825502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUND CARE CENTERS OF FLORIDA LLC

Provider Business Mailing Address
First Line	:	150 SOUTHPARK BLVD STE 102
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5122
Country	:	US
Telephone Number	:	904-342-5003
Fax Number	:	904-342-5550

Provider Business Practice Location Address
First Line	:	150 SOUTHPARK BLVD STE 102
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5122
Country	:	US
Telephone Number	:	904-342-5003
Fax Number	:	904-342-5550

Authorized Official
Title or Position	:	SOLE MBR
Name	:	JOHN C MILANICK
Credential	:	MD
Telephone Number	:	904-342-5003

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	03/05/2024

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Directions to “WOUND CARE CENTERS OF FLORIDA LLC ” Practice Location

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