Provider Demographics
NPI:1396938346
Name:WOUND CARE SPECIALISTS OF OHIO LLC
Entity type:Organization
Organization Name:WOUND CARE SPECIALISTS OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:513-478-5300
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-0004
Mailing Address - Country:US
Mailing Address - Phone:513-478-5300
Mailing Address - Fax:513-785-0667
Practice Address - Street 1:670 WINDING WOODS DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-9170
Practice Address - Country:US
Practice Address - Phone:513-478-5300
Practice Address - Fax:513-785-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-06865363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9343091Medicare PIN