Provider Demographics
NPI:1285257402
Name:ADVANCED SKIN AND WOUND CARE SOLUTIONS LLC
Entity Type:Organization
Organization Name:ADVANCED SKIN AND WOUND CARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-621-3109
Mailing Address - Street 1:2 ZUNI CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8725
Mailing Address - Country:US
Mailing Address - Phone:850-621-3109
Mailing Address - Fax:
Practice Address - Street 1:2 ZUNI CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8725
Practice Address - Country:US
Practice Address - Phone:850-621-3109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106126600Medicaid