Provider Demographics
NPI:1295554400
Name:ELITE WOUND CARE LLC
Entity type:Organization
Organization Name:ELITE WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SYDNI
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-351-1791
Mailing Address - Street 1:1365 FLOWERING DOGWOOD LN STE F
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2884
Mailing Address - Country:US
Mailing Address - Phone:731-777-9797
Mailing Address - Fax:
Practice Address - Street 1:1365 FLOWERING DOGWOOD LN STE F
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2884
Practice Address - Country:US
Practice Address - Phone:731-777-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty