Provider Demographics
NPI:1497460489
Name:ARCHOS WOUND SPECIALISTS INC
Entity Type:Organization
Organization Name:ARCHOS WOUND SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADRANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-800-0957
Mailing Address - Street 1:1328 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2131
Mailing Address - Country:US
Mailing Address - Phone:847-800-0957
Mailing Address - Fax:847-972-1863
Practice Address - Street 1:2720 S RIVER RD STE 4
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-4109
Practice Address - Country:US
Practice Address - Phone:708-305-6086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL74037844OtherSECRETARY OF STATE FILE NUMBER