Provider Demographics
NPI:1417216474
Name:WOUND CARE CONSULTANTS OF LITTLE ROCK, PLLC
Entity Type:Organization
Organization Name:WOUND CARE CONSULTANTS OF LITTLE ROCK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-349-8030
Mailing Address - Street 1:317 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4250
Mailing Address - Country:US
Mailing Address - Phone:501-349-8030
Mailing Address - Fax:501-353-2143
Practice Address - Street 1:106 S RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4708
Practice Address - Country:US
Practice Address - Phone:501-349-8030
Practice Address - Fax:501-353-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4980207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102792001Medicaid
ARC4980OtherPHYSICIAN LICENSE NUMBER
ARB90646Medicare UPIN