Provider Demographics
NPI:1598776916
Name:WOOD HEALTH COMPANY LLC
Entity Type:Organization
Organization Name:WOOD HEALTH COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KORDUCKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-373-7607
Mailing Address - Street 1:745 HASKINS RD STE B
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1600
Mailing Address - Country:US
Mailing Address - Phone:419-373-7607
Mailing Address - Fax:419-353-7076
Practice Address - Street 1:1039 HASKINS RD UNIT A
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9066
Practice Address - Country:US
Practice Address - Phone:419-373-7607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4066298OtherUNSPECIFIED
OH4172061OtherUNSPECIFIED
OHNP19111OtherUNSPECIFIED
OH0788622OtherUNSPECIFIED
OH2274686Medicaid
OH0151562Medicaid
OH2606031Medicaid
OH2344529Medicaid
OH2569049Medicaid
OH2595599Medicaid
OH4065703OtherUNSPECIFIED
OH4172691OtherUNSPECIFIED
OH4066298OtherUNSPECIFIED
OHQ44073Medicare UPIN
OH4172691OtherUNSPECIFIED
OH2344529Medicaid
OH2606031Medicaid
OH9336411Medicare PIN
OH0151562Medicaid
OHH53999Medicare UPIN