Provider Demographics
NPI:1578682779
Name:WOODS MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:WOODS MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-222-2292
Mailing Address - Street 1:250 S HICKMAN ST
Mailing Address - Street 2:
Mailing Address - City:PUXICO
Mailing Address - State:MO
Mailing Address - Zip Code:63960-9122
Mailing Address - Country:US
Mailing Address - Phone:573-222-2292
Mailing Address - Fax:573-222-2383
Practice Address - Street 1:250 S HICKMAN ST
Practice Address - Street 2:
Practice Address - City:PUXICO
Practice Address - State:MO
Practice Address - Zip Code:63960-9122
Practice Address - Country:US
Practice Address - Phone:573-222-2292
Practice Address - Fax:573-222-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263926Medicare Oscar/Certification