MEDICARE: FL WOUND CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	261QM1300X	Multi-Specialty Clinic/Center
3	163WW0000X	Wound Care Registered Nurse
4	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician

General Provider Information

NPI Number	:	1760267314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FL WOUND CARE LLC

Provider Business Mailing Address
First Line	:	11 ISLAND AVE APT 1808
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-1342
Country	:	US
Telephone Number	:	954-638-8615
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 ISLAND AVE APT 1808
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-1342
Country	:	US
Telephone Number	:	954-638-8615
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JONATHAN L SNYDERMAN
Credential	:	DO
Telephone Number	:	954-638-8615

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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