Provider Demographics
NPI:1386711554
Name:WOOD HEALTH CARE CLINIC PC
Entity type:Organization
Organization Name:WOOD HEALTH CARE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-845-2500
Mailing Address - Street 1:1307 LAFAYETTE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-2316
Mailing Address - Country:US
Mailing Address - Phone:304-845-2500
Mailing Address - Fax:304-845-2624
Practice Address - Street 1:1307 LAFAYETTE AVENUE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLLE
Practice Address - State:WV
Practice Address - Zip Code:26041-2316
Practice Address - Country:US
Practice Address - Phone:304-845-2500
Practice Address - Fax:304-845-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0008910000Medicaid
OH0995071Medicaid
WV0008910001OtherLAB NUMBER
OH0995071Medicaid