# INTEGRATED WOUND SPECIALISTS OF ELIZABETH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DIVERSIFIED CLINICAL SERVICES
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1437478898
- **Legal business name:** DIVERSIFIED CLINICAL SERVICES
- **Authorized official:** FRANK WILLIAMS (CEO)
- **Authorized official phone:** (904) 446-3519

## Contact information

- **Practice address:** 240 WILLIAMSON ST, SUITE 104, ELIZABETH, NJ 07202-3674
- **Practice address phone:** (908) 994-5480
- **Practice address fax:** (908) 994-8802
- **Mailing address:** PO BOX 848591, BOSTON, MA 02284-8591
- **Mailing address phone:** (904) 446-3451
- **Mailing address fax:** (904) 446-3451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 2083P0011X | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician | — | NULL | Yes |
| 2083P0011X | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/25/2010
- **Last updated:** 06/01/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 200454 | GROUP MEDICARE PTAN | NJ |