Basic Information
| Provider Information | |||||||||
| NPI: | 1780929455 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODWARD HEALTH SYSTEM LLC | ||||||||
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| OtherOrganizationName: | WOODWARD CLINICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689022 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370689022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007097338 | ||||||||
| FaxNumber: | 6154653007 | ||||||||
| Practice Location | |||||||||
| Address1: | 1810 KANSAS AVE | ||||||||
| Address2: | |||||||||
| City: | WOODWARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 738012912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802543174 | ||||||||
| FaxNumber: | 5802543502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 01/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | PEOPLES | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VP PHYSICIAN OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6145657585 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WOODWARD HEALTH SYSTEM LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.