Provider Demographics
NPI:1376698563
Name:WOUND CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:WOUND CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:773-354-8990
Mailing Address - Street 1:2605 LINCOLN HWY
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1846
Mailing Address - Country:US
Mailing Address - Phone:773-354-8990
Mailing Address - Fax:
Practice Address - Street 1:2605 LINCOLN HWY
Practice Address - Street 2:SUITE 121
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1846
Practice Address - Country:US
Practice Address - Phone:773-354-8990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty