Integrated Wound Care South Carolina Llc | |
1703 Laurel St Columbia SC 29201-2660 | |
(718) 963-3495 | |
Not Available |
Full Name | Integrated Wound Care South Carolina Llc |
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Speciality | General Practice |
Location | 1703 Laurel St, Columbia, South Carolina |
Authorized Official Name and Position | Diane Lusas (AUTHORIZED OFFICIAL) |
Authorized Official Contact | 7189633495 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Integrated Wound Care South Carolina Llc 492c Cedar Ln Ste 514 Teaneck NJ 07666-1713 Ph: (718) 963-3495 | Integrated Wound Care South Carolina Llc 1703 Laurel St Columbia SC 29201-2660 Ph: (718) 963-3495 |
NPI Number | 1235823121 |
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Provider Enumeration Date | 06/05/2023 |
Last Update Date | 06/05/2023 |
Medicare PECOS PAC ID | 0446610711 |
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Medicare Enrollment ID | O20230718002752 |
Identifier | Type | State | Issuer |
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1235823121 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Diane Lusas |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1730475658 PECOS PAC ID: 9032430640 Enrollment ID: I20230718003021 |
Provider Name | Christine Moffett |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164668224 PECOS PAC ID: 6901963123 Enrollment ID: I20230721000934 |
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