Provider Demographics
NPI:1487964904
Name:WOUND SOLUTIONS LLC
Entity type:Organization
Organization Name:WOUND SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-953-1566
Mailing Address - Street 1:17311 N GOLDEN DR
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9677
Mailing Address - Country:US
Mailing Address - Phone:509-953-1566
Mailing Address - Fax:
Practice Address - Street 1:3807 E BISMARK AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-6504
Practice Address - Country:US
Practice Address - Phone:509-279-2629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602825451332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA332B00000XMedicaid
MT1487964904Medicaid
ID807670500Medicaid
MT1487964904Medicaid