Provider Demographics
NPI:1851924625
Name:COMMUNITY WOUND RESOURCE, LLC
Entity Type:Organization
Organization Name:COMMUNITY WOUND RESOURCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-967-7970
Mailing Address - Street 1:1600 S HENDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3518
Mailing Address - Country:US
Mailing Address - Phone:903-475-2713
Mailing Address - Fax:903-942-2930
Practice Address - Street 1:1600 S HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3518
Practice Address - Country:US
Practice Address - Phone:903-475-2713
Practice Address - Fax:903-942-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty