Provider Demographics
NPI:1114320645
Name:WOUND CLINICS OF AMERICA CORP.
Entity Type:Organization
Organization Name:WOUND CLINICS OF AMERICA CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VIAMONTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-486-2538
Mailing Address - Street 1:4440 PGA BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6539
Mailing Address - Country:US
Mailing Address - Phone:772-486-2538
Mailing Address - Fax:561-249-3062
Practice Address - Street 1:4440 PGA BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6539
Practice Address - Country:US
Practice Address - Phone:772-486-2538
Practice Address - Fax:561-249-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44853208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85759Medicare UPIN