Provider Demographics
NPI:1659965457
Name:OHIO WOUND CARE ASSOCIATES LLC
Entity type:Organization
Organization Name:OHIO WOUND CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMBERG
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:609-517-2526
Mailing Address - Street 1:5741 SHIELDS RD STE B
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9814
Mailing Address - Country:US
Mailing Address - Phone:330-559-5115
Mailing Address - Fax:
Practice Address - Street 1:12301 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3744
Practice Address - Country:US
Practice Address - Phone:440-652-8748
Practice Address - Fax:440-582-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty