Provider Demographics
NPI:1104830058
Name:WOUND TREATMENT SERVICES OF AMERICA,LLC
Entity Type:Organization
Organization Name:WOUND TREATMENT SERVICES OF AMERICA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-981-9699
Mailing Address - Street 1:117 S COOK ST # 240
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4311
Mailing Address - Country:US
Mailing Address - Phone:847-525-8550
Mailing Address - Fax:
Practice Address - Street 1:117 S COOK ST # 240
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4311
Practice Address - Country:US
Practice Address - Phone:847-525-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633976OtherBC
IL01633976OtherBC
ILK19814Medicare ID - Type Unspecified
IL212087Medicare ID - Type UnspecifiedM/C GROUP