Provider Demographics
NPI:1770971863
Name:INTEGRATIVE WOUND CARE SOLUTIONS, LLC
Entity type:Organization
Organization Name:INTEGRATIVE WOUND CARE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LANWAY
Authorized Official - Middle Name:HILLARY
Authorized Official - Last Name:LING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-529-8222
Mailing Address - Street 1:3298 SUMMIT BLVD
Mailing Address - Street 2:39
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-8318
Mailing Address - Country:US
Mailing Address - Phone:850-529-8222
Mailing Address - Fax:850-912-4465
Practice Address - Street 1:3298 SUMMIT BLVD
Practice Address - Street 2:39
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-529-8222
Practice Address - Fax:850-912-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty