Provider Demographics
NPI:1467633149
Name:MAHONING VALLEY WOUND CARE, INC.
Entity Type:Organization
Organization Name:MAHONING VALLEY WOUND CARE, INC.
Other - Org Name:FELIX A. PESA, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:A
Authorized Official - Last Name:PESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-480-2078
Mailing Address - Street 1:540 PARMALEE AVE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1716
Mailing Address - Country:US
Mailing Address - Phone:330-480-2078
Mailing Address - Fax:
Practice Address - Street 1:540 PARMALEE AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1716
Practice Address - Country:US
Practice Address - Phone:330-480-2078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340259172086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000291311OtherANTHEM
OH341107457027OtherCARESOURCE
OH0118938Medicaid
OHP00199613OtherMEDICARE/RR
OH0118938Medicaid
OH341107457027OtherCARESOURCE