Provider Demographics
NPI:1225451057
Name:TCMC WOUND CARE, LLC
Entity Type:Organization
Organization Name:TCMC WOUND CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-228-4541
Mailing Address - Street 1:875 HIGHWAY 321 N
Mailing Address - Street 2:SUITE 600-227
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-7397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10820 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1956
Practice Address - Country:US
Practice Address - Phone:865-218-2302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD018122261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN174400000XOtherTAXONOMY CODE
TN3029164Medicaid
TN1124181532OtherMEDICARE NPI
TN1124181532OtherMEDICARE NPI