Basic Information
| Provider Information | |||||||||
| NPI: | 1417193681 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOUND SPECIALISTS OF GREATER CINCINNATI, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 643911 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452643911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135573330 | ||||||||
| FaxNumber: | 5135573329 | ||||||||
| Practice Location | |||||||||
| Address1: | 10500 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452424402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138651111 | ||||||||
| FaxNumber: | 5135573329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2008 | ||||||||
| LastUpdateDate: | 03/24/2016 | ||||||||
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| AuthorizedOfficialLastName: | MASTURZO | ||||||||
| AuthorizedOfficialFirstName: | ARTI | ||||||||
| AuthorizedOfficialMiddleName: | BALAR | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5135573330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-082412 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207PE0005X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine | 2083P0011X | 35-082412 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64096233 | 05 | KY | MEDICAID | 2993891 | 05 | OH | MEDICAID | 7100118600 | 05 | KY | MEDICAID |