Provider Demographics
NPI:1255673943
Name:NOVA WOUND CARE, P.C.
Entity Type:Organization
Organization Name:NOVA WOUND CARE, P.C.
Other - Org Name:TKR GROUP, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-652-4251
Mailing Address - Street 1:32370 LANKFORD HWY
Mailing Address - Street 2:
Mailing Address - City:PAINTER
Mailing Address - State:VA
Mailing Address - Zip Code:23420-2410
Mailing Address - Country:US
Mailing Address - Phone:703-652-4251
Mailing Address - Fax:703-652-8470
Practice Address - Street 1:32370 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:PAINTER
Practice Address - State:VA
Practice Address - Zip Code:23420-2410
Practice Address - Country:US
Practice Address - Phone:757-782-9157
Practice Address - Fax:703-652-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255673943Medicaid