NPIMap

Organization Active NPI

Wound Care Clinic - Esu, Inc.

  • Clinic/Center
  • Pooler, GA
National Provider Identifier
1154319408
Registry record updated Feb 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
WOUND CARE CLINIC - ESU, INC.
Practice address
1000 Towne Center Blvd
Suite 705
Pooler, GA 31322-4052
Phone
(912) 272-9494
Fax
(912) 998-0041
NPI assigned
Oct 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paula Kreissler
Title
President/Ceo
Phone
(912) 272-9494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1000 Towne Center Blvd
Suite 705
Pooler, GA 31322-4052

Mailing address

PO Box 9910
Savannah, GA 31412-0110
Phone (912) 272-9494

Other identifiers 1

IdentifierTypeStateIssuer
559348415AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051114000897 GA Part B Supplier - Clinic/Group Practice 9436178910 Receives reassigned benefits from 6 practitioners
Practice locations: Pooler, GA

National Provider Directory

National Provider Directory
Tax ID family
Wound Care Clinic - Esu2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1215 US Highway 80 E
Ste 700
Pooler, GA 31322
Phone (912) 998-0040

815 E 68th St
#2
Savannah, GA 31405
Phone (912) 691-2614

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1154319408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9910",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314120110",
            "telephone_number": "912-272-9494",
            "fax_number": "912-998-0041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 TOWNE CENTER BLVD",
            "address_2": "SUITE 705",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224052",
            "telephone_number": "912-272-9494",
            "fax_number": "912-998-0041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOUND CARE CLINIC - ESU, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "KREISSLER",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "912-272-9494"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "559348415A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pooler, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.