Provider Demographics
NPI:1497938484
Name:WOODLAND CLINIC
Entity Type:Organization
Organization Name:WOODLAND CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-755-7366
Mailing Address - Street 1:610 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5047
Mailing Address - Country:US
Mailing Address - Phone:406-755-7366
Mailing Address - Fax:406-755-7277
Practice Address - Street 1:705 6TH AVE E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5008
Practice Address - Country:US
Practice Address - Phone:406-755-7366
Practice Address - Fax:406-755-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty