Provider Demographics
NPI:1316944283
Name:JONATHAN H WOODCOCK MD & ASSOC PC
Entity type:Organization
Organization Name:JONATHAN H WOODCOCK MD & ASSOC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:WOODCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-288-7882
Mailing Address - Street 1:8515 PEARL ST
Mailing Address - Street 2:203
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4809
Mailing Address - Country:US
Mailing Address - Phone:303-288-7882
Mailing Address - Fax:303-288-7874
Practice Address - Street 1:8515 PEARL ST
Practice Address - Street 2:203
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4809
Practice Address - Country:US
Practice Address - Phone:303-288-7882
Practice Address - Fax:303-288-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO294362084P0800X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04019857Medicaid
COWOL5918OtherANTHEM BLUE CROSS BLUE SH
COJOL5908OtherANTHEM BLUE CROSS BLUE SH
CO04019857Medicaid