Provider Demographics
NPI:1265764856
Name:ADVANCED WOUND CARE OF NC INC.
Entity type:Organization
Organization Name:ADVANCED WOUND CARE OF NC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHE
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:WASIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-202-3170
Mailing Address - Street 1:160 MACGREGOR PINES DR
Mailing Address - Street 2:206
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6036
Mailing Address - Country:US
Mailing Address - Phone:336-202-3170
Mailing Address - Fax:866-903-7036
Practice Address - Street 1:160 MACGREGOR PINES DR
Practice Address - Street 2:206
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6036
Practice Address - Country:US
Practice Address - Phone:336-202-3170
Practice Address - Fax:866-903-7036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies