Provider Demographics
NPI:1962439232
Name:WOUND CARE RESOURCES INC.
Entity Type:Organization
Organization Name:WOUND CARE RESOURCES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT/OFFICER BIODERM, INC.
Authorized Official - Prefix:
Authorized Official - First Name:GAET
Authorized Official - Middle Name:
Authorized Official - Last Name:TYRANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-507-7655
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38389-0155
Mailing Address - Country:US
Mailing Address - Phone:731-643-6660
Mailing Address - Fax:731-643-6800
Practice Address - Street 1:4 NEWBERN HWY
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:TN
Practice Address - Zip Code:38389-0009
Practice Address - Country:US
Practice Address - Phone:731-643-6660
Practice Address - Fax:731-643-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455111Medicaid
TN1455111Medicaid