Basic Information
| Provider Information | |||||||||
| NPI: | 1881035343 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATIVE WOUND CARE ASSOCIATES, INC | ||||||||
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| OtherOrganizationName: | NATURE-ALL INC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N KEEL RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161483440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004718592 | ||||||||
| FaxNumber: | 8667426901 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 BOARDMAN CANFIELD RD STE 3 | ||||||||
| Address2: | |||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445124344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667584862 | ||||||||
| FaxNumber: | 3307584886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2013 | ||||||||
| LastUpdateDate: | 07/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | BALKO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7243470591 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 3951291 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.