Provider Demographics
NPI:1417781691
Name:MONTGOMERY COUNTY WOUND HEALING CENTER LLC
Entity type:Organization
Organization Name:MONTGOMERY COUNTY WOUND HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ODURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-378-2424
Mailing Address - Street 1:583 SHOEMAKER RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4201
Mailing Address - Country:US
Mailing Address - Phone:484-378-2424
Mailing Address - Fax:
Practice Address - Street 1:583 SHOEMAKER RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4201
Practice Address - Country:US
Practice Address - Phone:484-378-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty