Provider Demographics
NPI:1497503452
Name:QUALITY WOUND CARE LLC
Entity type:Organization
Organization Name:QUALITY WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIYAMIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-405-4416
Mailing Address - Street 1:26061 W 150TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-8511
Mailing Address - Country:US
Mailing Address - Phone:913-405-4416
Mailing Address - Fax:
Practice Address - Street 1:12022 BLUE VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2647
Practice Address - Country:US
Practice Address - Phone:913-405-4416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty