Provider Demographics
NPI:1780777979
Name:PRIME WOUND CARE SOLUTIONS LLC
Entity type:Organization
Organization Name:PRIME WOUND CARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIRS
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:401-497-2204
Mailing Address - Street 1:3047 E MAIN RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4262
Mailing Address - Country:US
Mailing Address - Phone:401-251-4253
Mailing Address - Fax:800-887-9762
Practice Address - Street 1:3047 E MAIN RD STE 2A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4262
Practice Address - Country:US
Practice Address - Phone:401-251-4253
Practice Address - Fax:800-887-9762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3520001Medicaid
MA1540572Medicaid
RI3520001Medicaid