Provider Demographics
NPI:1528825502
Name:WOUND CARE CENTERS OF FLORIDA LLC
Entity type:Organization
Organization Name:WOUND CARE CENTERS OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILANICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-342-5003
Mailing Address - Street 1:150 SOUTHPARK BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5122
Mailing Address - Country:US
Mailing Address - Phone:904-342-5003
Mailing Address - Fax:904-342-5550
Practice Address - Street 1:150 SOUTHPARK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5122
Practice Address - Country:US
Practice Address - Phone:904-342-5003
Practice Address - Fax:904-342-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty