| Integrated Wound Care Arkansas Pllc | |
|
300 S Spring St Little Rock AR 72201-2444 | |
| (201) 870-1194 | |
| Not Available |
| Full Name | Integrated Wound Care Arkansas Pllc |
|---|---|
| Speciality | General Practice |
| Location | 300 S Spring St, Little Rock, Arkansas |
| Authorized Official Name and Position | Diane Lusas (MEMBER) |
| Authorized Official Contact | 2018701194 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Wound Care Arkansas Pllc 492c Cedar Ln Ste 514 Teaneck NJ 07666-1713 Ph: (201) 870-1194 | Integrated Wound Care Arkansas Pllc 300 S Spring St Little Rock AR 72201-2444 Ph: (201) 870-1194 |
| NPI Number | 1760110282 |
|---|---|
| Provider Enumeration Date | 08/11/2022 |
| Last Update Date | 09/07/2022 |
| Medicare PECOS PAC ID | 4587040597 |
|---|---|
| Medicare Enrollment ID | O20220928002931 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760110282 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Panfilo Estrada-flores |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154889707 PECOS PAC ID: 5193055622 Enrollment ID: I20190926002148 |
| Provider Name | Diane Lusas |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1730475658 PECOS PAC ID: 9032430640 Enrollment ID: I20220929003430 |
| Provider Name | Audrey R Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487390118 PECOS PAC ID: 4385014083 Enrollment ID: I20221221000344 |
| Provider Name | Shelby E Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659918936 PECOS PAC ID: 6406220987 Enrollment ID: I20230323003077 |
| Provider Name | Tracey Lashay Franklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982114252 PECOS PAC ID: 7911365234 Enrollment ID: I20230620000277 |
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