Provider Demographics
NPI:1639561533
Name:MEREDITH WOODWARD MD INC
Entity Type:Organization
Organization Name:MEREDITH WOODWARD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-432-5570
Mailing Address - Street 1:10474 N DOHENY DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-0798
Mailing Address - Country:US
Mailing Address - Phone:559-281-3220
Mailing Address - Fax:267-381-6355
Practice Address - Street 1:1381 E HERNDON AVE
Practice Address - Street 2:STE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3307
Practice Address - Country:US
Practice Address - Phone:559-281-3220
Practice Address - Fax:267-381-6355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEREDITH WOODWARD MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-02
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57994207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G579940OtherMEDICARE ID UNSPECIFIED