Provider Demographics
NPI:1255039020
Name:SEACOAST WOUND CARE PLLC
Entity type:Organization
Organization Name:SEACOAST WOUND CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PHELPS
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:207-272-9901
Mailing Address - Street 1:200 LAFAYETTE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:NORTH HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03862-2461
Mailing Address - Country:US
Mailing Address - Phone:207-272-9901
Mailing Address - Fax:
Practice Address - Street 1:11 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3226
Practice Address - Country:US
Practice Address - Phone:603-330-7914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30207888Medicaid