| Logos Wound Care Solutions, LLC | |
|
1200 Woodruff Rd Ste 187 Building A3 Greenville SC 29607-5730 | |
| (801) 712-2075 | |
| Not Available |
| Full Name | Logos Wound Care Solutions, LLC |
|---|---|
| Speciality | Registered Nurse |
| Location | 1200 Woodruff Rd Ste 187 Building A3, Greenville, South Carolina |
| Authorized Official Name and Position | Broderick Hekking (MSO) |
| Authorized Official Contact | 8644810935 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Logos Wound Care Solutions, LLC 1200 Woodruff Rd Ste 187 Greenville SC 29607-5730 Ph: (801) 712-2075 | Logos Wound Care Solutions, LLC 1200 Woodruff Rd Ste 187 Building A3 Greenville SC 29607-5730 Ph: (801) 712-2075 |
| NPI Number | 1841055092 |
|---|---|
| Provider Enumeration Date | 02/16/2024 |
| Last Update Date | 04/28/2025 |
| Certification Date | 04/28/2025 |
| Medicare PECOS PAC ID | 6709325723 |
|---|---|
| Medicare Enrollment ID | O20240822000578 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841055092 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Secondary |
| 163WW0000X | Registered Nurse - Wound Care | (NU) | Primary |
| 253Z00000X | In Home Supportive Care | (NU) | Secondary |
| Provider Name | Kerry Wheeler |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1164545224 PECOS PAC ID: 7618126590 Enrollment ID: I20121009000829 |
| Provider Name | Robert M Lauderdale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952861536 PECOS PAC ID: 3678803723 Enrollment ID: I20191002003094 |
| Provider Name | Joseph Foy Larson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679226021 PECOS PAC ID: 3971999046 Enrollment ID: I20220330000971 |
| Provider Name | Christian Alexendria Dicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710661095 PECOS PAC ID: 6800259615 Enrollment ID: I20230828000737 |
| Provider Name | Meghan Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396459863 PECOS PAC ID: 8820516701 Enrollment ID: I20250514002861 |
| Provider Name | Jennifer Meehan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548333032 PECOS PAC ID: 5395843130 Enrollment ID: I20250523001594 |
| Provider Name | Kristina G. Aldrich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770191652 PECOS PAC ID: 2466963210 Enrollment ID: I20250618000539 |
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