Provider Demographics
NPI:1912253865
Name:L BILLY WOUNDCARE LLC
Entity Type:Organization
Organization Name:L BILLY WOUNDCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-797-2611
Mailing Address - Street 1:9375 E VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-3218
Mailing Address - Country:US
Mailing Address - Phone:636-797-2611
Mailing Address - Fax:636-797-2611
Practice Address - Street 1:3933 S BROADWAY
Practice Address - Street 2:LIMB PRESERVATION CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4601
Practice Address - Country:US
Practice Address - Phone:314-865-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO30514208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200026920Medicaid
MOA10912Medicare UPIN
MO000003344Medicare PIN