Provider Demographics
NPI:1457681025
Name:WOODLANDS MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:WOODLANDS MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUPERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMAC
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:864-517-2066
Mailing Address - Street 1:155 BROZZINI CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5340
Mailing Address - Country:US
Mailing Address - Phone:864-517-2066
Mailing Address - Fax:800-694-5720
Practice Address - Street 1:155 BROZZINI CT
Practice Address - Street 2:SUITE E
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5340
Practice Address - Country:US
Practice Address - Phone:864-517-2066
Practice Address - Fax:800-694-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty