Provider Demographics
NPI:1912143603
Name:PREVENTATIVE WOUND CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:PREVENTATIVE WOUND CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-230-6698
Mailing Address - Street 1:PO BOX 1457
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33779-1457
Mailing Address - Country:US
Mailing Address - Phone:727-239-3713
Mailing Address - Fax:727-230-9046
Practice Address - Street 1:9956 SAGO POINT DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-4913
Practice Address - Country:US
Practice Address - Phone:727-239-3713
Practice Address - Fax:727-230-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLR300620764440207N00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty