Provider Demographics
NPI:1417965187
Name:CLINICAL WOUND SOLUTIONS, LLC
Entity Type:Organization
Organization Name:CLINICAL WOUND SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-238-6580
Mailing Address - Street 1:1084 INDUSTRIAL DR
Mailing Address - Street 2:UNIT 5
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-1261
Mailing Address - Country:US
Mailing Address - Phone:630-238-6580
Mailing Address - Fax:630-238-6581
Practice Address - Street 1:1084 INDUSTRIAL DR
Practice Address - Street 2:UNIT 5
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-1261
Practice Address - Country:US
Practice Address - Phone:630-238-6580
Practice Address - Fax:630-238-6581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5763190001Medicare NSC