Provider Demographics
NPI:1295104396
Name:WOUND CARE CENTER AT GLASGOW
Entity type:Organization
Organization Name:WOUND CARE CENTER AT GLASGOW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-629-2273
Mailing Address - Street 1:507 S L ROGERS WELLS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1043
Mailing Address - Country:US
Mailing Address - Phone:270-629-2273
Mailing Address - Fax:270-629-2278
Practice Address - Street 1:507 S L ROGERS WELLS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1043
Practice Address - Country:US
Practice Address - Phone:270-629-2273
Practice Address - Fax:270-629-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK184430OtherMEDICARE PTAN
KY7100578180Medicaid