Provider Demographics
NPI:1548818735
Name:WOUND CARE CONTRACTORS, LLC
Entity type:Organization
Organization Name:WOUND CARE CONTRACTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-286-2781
Mailing Address - Street 1:444 KINGSTON PLANTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-3404
Mailing Address - Country:US
Mailing Address - Phone:318-286-2781
Mailing Address - Fax:
Practice Address - Street 1:444 KINGSTON PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-3404
Practice Address - Country:US
Practice Address - Phone:318-272-6847
Practice Address - Fax:318-900-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-30
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty