MEDICARE: TN WOUND CARE MEDICAL GROUP

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1750008991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TN WOUND CARE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	5901 W CENTURY BLVD STE 750
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5443
Country	:	US
Telephone Number	:	323-480-4075
Fax Number	:

Provider Business Practice Location Address
First Line	:	3117 NORBROOK DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38116-1614
Country	:	US
Telephone Number	:	323-480-4075
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OWEN BERNARDO ELLINGTON
Credential	:	MD
Telephone Number	:	713-304-4227

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	10/27/2022

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Directions to “TN WOUND CARE MEDICAL GROUP ” Practice Location

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