Provider Demographics
NPI:1528847506
Name:HV WOUND CARE CENTER
Entity type:Organization
Organization Name:HV WOUND CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIMITRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTZOROS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:936-522-6838
Mailing Address - Street 1:100 MEDICAL CENTER BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2821
Mailing Address - Country:US
Mailing Address - Phone:936-522-6838
Mailing Address - Fax:
Practice Address - Street 1:643 INTERSTATE 45 S
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-6434
Practice Address - Country:US
Practice Address - Phone:936-522-6838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty