Provider Demographics
NPI:1033277686
Name:ADVANCED WOUND & LIMB CARE CENTER INC.
Entity Type:Organization
Organization Name:ADVANCED WOUND & LIMB CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-232-0957
Mailing Address - Street 1:1216 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3312
Mailing Address - Country:US
Mailing Address - Phone:812-232-0957
Mailing Address - Fax:812-242-1563
Practice Address - Street 1:1216 WABASH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3312
Practice Address - Country:US
Practice Address - Phone:812-232-0957
Practice Address - Fax:812-242-1563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000711A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100350020Medicaid
IN200896120Medicaid
IN247830Medicare ID - Type Unspecified
IN100350020Medicaid