Provider Demographics
NPI:1588173967
Name:WOODLANDS ADDICTION MEDICINE GROUP
Entity type:Organization
Organization Name:WOODLANDS ADDICTION MEDICINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-495-0223
Mailing Address - Street 1:1100 PARK CENTRAL BLVD S STE 3400
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-2265
Mailing Address - Country:US
Mailing Address - Phone:954-691-0856
Mailing Address - Fax:954-691-0834
Practice Address - Street 1:2610 TECHNOLOGY FOREST BLVD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3904
Practice Address - Country:US
Practice Address - Phone:954-691-0856
Practice Address - Fax:954-691-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty