Provider Demographics
NPI:1649997354
Name:WOUND & AMPUTATION PREVENTION LLC
Entity type:Organization
Organization Name:WOUND & AMPUTATION PREVENTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-253-0281
Mailing Address - Street 1:PO BOX 69528
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9398
Mailing Address - Country:US
Mailing Address - Phone:888-982-9227
Mailing Address - Fax:877-449-0702
Practice Address - Street 1:7335 YANKEE RD STE 101
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-0008
Practice Address - Country:US
Practice Address - Phone:888-982-9227
Practice Address - Fax:877-449-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty