Provider Demographics
NPI:1255068912
Name:WOUND CARE CONSULTANTS OF PENNSYLVANIA, LLC
Entity type:Organization
Organization Name:WOUND CARE CONSULTANTS OF PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ-SCHIAVONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-402-0027
Mailing Address - Street 1:23250 CHAGRIN BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5417
Mailing Address - Country:US
Mailing Address - Phone:216-402-0027
Mailing Address - Fax:330-574-1050
Practice Address - Street 1:1755 US ROUTE 6 W
Practice Address - Street 2:
Practice Address - City:ROULETTE
Practice Address - State:PA
Practice Address - Zip Code:16746-1025
Practice Address - Country:US
Practice Address - Phone:216-402-0027
Practice Address - Fax:330-574-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty