Provider Demographics
NPI:1063244838
Name:COMPREHENSIVE INFECTIOUS DISEASE CARE INC
Entity type:Organization
Organization Name:COMPREHENSIVE INFECTIOUS DISEASE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:740-632-5965
Mailing Address - Street 1:106 SADDLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-3726
Mailing Address - Country:US
Mailing Address - Phone:740-632-5965
Mailing Address - Fax:
Practice Address - Street 1:2416 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3639
Practice Address - Country:US
Practice Address - Phone:740-264-8567
Practice Address - Fax:740-346-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty