Provider Demographics
NPI:1235382276
Name:SANCURO WOUND CARE SYSTEMS, INC.
Entity Type:Organization
Organization Name:SANCURO WOUND CARE SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-864-1242
Mailing Address - Street 1:5097 S 900 E
Mailing Address - Street 2:STE. 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5768
Mailing Address - Country:US
Mailing Address - Phone:801-944-6000
Mailing Address - Fax:801-816-1426
Practice Address - Street 1:5097 S 900 E
Practice Address - Street 2:STE. 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5768
Practice Address - Country:US
Practice Address - Phone:801-944-6000
Practice Address - Fax:801-816-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1235382276Medicaid
UT1235382276Medicaid