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Organization

NATIONAL WOUND CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JOHNNY LEE PRINCE (PRESIDENT OWNER)
(217) 355-2680
Entity
Organization

Contact information

Practice address
4112B FIELDSTONE RD, CHAMPAIGN, IL 61822-8810
(217) 355-2680
(217) 355-5538
Mailing address
3356 BIG PINE TRL STE D, CHAMPAIGN, IL 61822-1405
(217) 355-2680
(217) 355-5538

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332BC3200X
Customized Equipment (DME)

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1029939
BLUE CROSS BLUE SHIELD
IL
01
1119627
PASSPORT
05
200397280A
IN
05
2208828
OH
05
28251100
FL
01
371386148
TRICARE
01
371386148001
PUBLIC AID
IL
05
4582222
TN
01
90001322
UNISYS
01
R9560
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/28/2006
Last updated
10/04/2017
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