Provider Demographics
NPI:1467678367
Name:ADVANCED WOUND CONCEPTS INC.
Entity Type:Organization
Organization Name:ADVANCED WOUND CONCEPTS INC.
Other - Org Name:PREFERRED DIABETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-595-0940
Mailing Address - Street 1:23366 COMMERCE PARK
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5850
Mailing Address - Country:US
Mailing Address - Phone:216-595-0940
Mailing Address - Fax:877-454-7463
Practice Address - Street 1:23366 COMMERCE PARK
Practice Address - Street 2:SUITE 208
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5850
Practice Address - Country:US
Practice Address - Phone:216-595-0940
Practice Address - Fax:877-454-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS061-18015-4332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03784897Medicaid
OH2992945Medicaid
MS5539220001Medicare ID - Type UnspecifiedMEDICARE NUMBER