Basic Information
| Provider Information | |||||||||
| NPI: | 1265804603 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOODWARD HEALTH SYSTEM LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ALLIANCEHEALTH WOODWARD CLINICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 17TH ST | ||||||||
| Address2: | |||||||||
| City: | WOODWARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 738012448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802565511 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1611 MAIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | WOODWARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 738013064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802548486 | ||||||||
| FaxNumber: | 5802548634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2015 | ||||||||
| LastUpdateDate: | 04/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | LALOR | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR/DELEGATED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6159254565 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 2252 | OK | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.