Provider Demographics
NPI:1558675892
Name:LYMPHEDEMA TREATMENT AND WOUND CARE DEVICES, LLC
Entity Type:Organization
Organization Name:LYMPHEDEMA TREATMENT AND WOUND CARE DEVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-543-5963
Mailing Address - Street 1:901 S HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3423
Mailing Address - Country:US
Mailing Address - Phone:773-543-5936
Mailing Address - Fax:888-226-3394
Practice Address - Street 1:901 S HAMILTON ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3423
Practice Address - Country:US
Practice Address - Phone:773-543-5936
Practice Address - Fax:888-226-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies