Provider Demographics
NPI:1073728325
Name:WOUNCARE PROVIDERS INC.
Entity Type:Organization
Organization Name:WOUNCARE PROVIDERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:JORRITSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-585-6123
Mailing Address - Street 1:4500 CAMPUS DR
Mailing Address - Street 2:# 560
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1814
Mailing Address - Country:US
Mailing Address - Phone:949-757-0880
Mailing Address - Fax:
Practice Address - Street 1:4500 CAMPUS DR
Practice Address - Street 2:# 560
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1814
Practice Address - Country:US
Practice Address - Phone:949-757-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5374940001Medicare ID - Type Unspecified