| Blc Wound Care Pllc | |
|
400 W Lyndon B Johnson Fwy Ste 130 Irving TX 75063-3700 | |
| (972) 990-5222 | |
| (972) 990-3900 |
| Full Name | Blc Wound Care Pllc |
|---|---|
| Speciality | Preventive Medicine |
| Location | 400 W Lyndon B Johnson Fwy Ste 130, Irving, Texas |
| Authorized Official Name and Position | Brad Taylor Landrum (OWNER) |
| Authorized Official Contact | 8177930513 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blc Wound Care Pllc 9819 Edgecove Dr Dallas TX 75238-1535 Ph: (817) 793-0513 | Blc Wound Care Pllc 400 W Lyndon B Johnson Fwy Ste 130 Irving TX 75063-3700 Ph: (972) 990-5222 |
| NPI Number | 1508500638 |
|---|---|
| Provider Enumeration Date | 04/25/2022 |
| Last Update Date | 09/15/2023 |
| Medicare PECOS PAC ID | 8729465109 |
|---|---|
| Medicare Enrollment ID | O20220525000483 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508500638 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 2083P0011X | Preventive Medicine - Undersea And Hyperbaric Medicine | (* (Not Available)) | Primary |
| Provider Name | Brad T Landrum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356870620 PECOS PAC ID: 2567886997 Enrollment ID: I20210810003721 |
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