Provider Demographics
NPI:1922706258
Name:WOUND CURE SPECIALISTS
Entity Type:Organization
Organization Name:WOUND CURE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-281-6172
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80160-0040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135 PONDEROSA AVE
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:SD
Practice Address - Zip Code:57745-6057
Practice Address - Country:US
Practice Address - Phone:303-525-7250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty