Provider Demographics
NPI:1881035343
Name:INNOVATIVE WOUND CARE ASSOCIATES, INC
Entity Type:Organization
Organization Name:INNOVATIVE WOUND CARE ASSOCIATES, INC
Other - Org Name:NATURE-ALL INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BALKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-347-0591
Mailing Address - Street 1:100 N KEEL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3440
Mailing Address - Country:US
Mailing Address - Phone:800-471-8592
Mailing Address - Fax:866-742-6901
Practice Address - Street 1:790 BOARDMAN CANFIELD RD STE 3
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4344
Practice Address - Country:US
Practice Address - Phone:866-758-4862
Practice Address - Fax:330-758-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39512912086S0129X
OH2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty