Provider Demographics
NPI:1467748772
Name:KENNETH W WOOD MD LLC
Entity Type:Organization
Organization Name:KENNETH W WOOD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-854-9880
Mailing Address - Street 1:315 N WASHINGTON AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2623
Mailing Address - Country:US
Mailing Address - Phone:931-854-9880
Mailing Address - Fax:931-854-0919
Practice Address - Street 1:315 N WASHINGTON AVE STE 130
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2623
Practice Address - Country:US
Practice Address - Phone:931-854-9880
Practice Address - Fax:931-854-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty