Provider Demographics
NPI:1639368335
Name:WOODWORTH FAMILY MEDICINE INC.
Entity Type:Organization
Organization Name:WOODWORTH FAMILY MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VANMOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-484-9588
Mailing Address - Street 1:P.O.BOX406
Mailing Address - Street 2:
Mailing Address - City:WOODWORTH
Mailing Address - State:LA
Mailing Address - Zip Code:71485
Mailing Address - Country:US
Mailing Address - Phone:318-484-9588
Mailing Address - Fax:318-484-9590
Practice Address - Street 1:9372 HWY.165 SOUTH
Practice Address - Street 2:
Practice Address - City:WOODWORTH
Practice Address - State:LA
Practice Address - Zip Code:71485
Practice Address - Country:US
Practice Address - Phone:318-484-9588
Practice Address - Fax:318-484-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA119261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494437Medicaid