Provider Demographics
NPI:1528245255
Name:DON WOODS DO PROFESSIONAL SERVICE CORPORATION
Entity type:Organization
Organization Name:DON WOODS DO PROFESSIONAL SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-783-3744
Mailing Address - Street 1:5219 W CLEARWATER AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1914
Mailing Address - Country:US
Mailing Address - Phone:509-783-3744
Mailing Address - Fax:509-736-0771
Practice Address - Street 1:5219 W CLEARWATER AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1914
Practice Address - Country:US
Practice Address - Phone:509-783-3744
Practice Address - Fax:509-736-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000519208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAD33735Medicare UPIN
WA8853754Medicare PIN