MEDICARE: WOUND CARE EXPRESS, 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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1881118800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUND CARE EXPRESS, LLC

Provider Business Mailing Address
First Line	:	3109 CHAPARRAL LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2004
Country	:	US
Telephone Number	:	817-832-3606
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 CHAPARRAL LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2004
Country	:	US
Telephone Number	:	817-832-3606
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CRAIG EVAN PRESNALL
Credential	:
Telephone Number	:	817-832-3606

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	08/01/2017

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