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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