Provider Demographics
NPI:1710313861
Name:WOUNDCAREMAX PLLC
Entity Type:Organization
Organization Name:WOUNDCAREMAX PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMONA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-820-9727
Mailing Address - Street 1:PO BOX 7183
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-0616
Mailing Address - Country:US
Mailing Address - Phone:509-491-3256
Mailing Address - Fax:509-579-0141
Practice Address - Street 1:1268 LEE BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4231
Practice Address - Country:US
Practice Address - Phone:509-942-2660
Practice Address - Fax:509-942-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044678174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty