Provider Demographics
NPI:1467458760
Name:DR. VIC WOOD INC
Entity Type:Organization
Organization Name:DR. VIC WOOD INC
Other - Org Name:DOCTORS URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-232-1020
Mailing Address - Street 1:PO BOX 6745
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0917
Mailing Address - Country:US
Mailing Address - Phone:304-233-9314
Mailing Address - Fax:304-233-0265
Practice Address - Street 1:24 HOMESTEAD AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6638
Practice Address - Country:US
Practice Address - Phone:304-232-1020
Practice Address - Fax:304-232-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2077989Medicaid
WV0007051000Medicaid
WV9921111Medicare PIN