Provider Demographics
NPI:1649215583
Name:NORTHEAST SURGICAL WOUND CARE, INC.
Entity Type:Organization
Organization Name:NORTHEAST SURGICAL WOUND CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVSEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-643-2780
Mailing Address - Street 1:6100 ROCKSIDE WOODS BLVD
Mailing Address - Street 2:SUITE 425
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2366
Mailing Address - Country:US
Mailing Address - Phone:216-643-2780
Mailing Address - Fax:216-524-0111
Practice Address - Street 1:6100 ROCKSIDE WOODS BLVD
Practice Address - Street 2:SUITE 425
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2366
Practice Address - Country:US
Practice Address - Phone:216-643-2780
Practice Address - Fax:216-524-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2119380Medicaid
OH9311903Medicare PIN