Provider Demographics
NPI:1659667376
Name:BETSY E. WOOD DO PA
Entity Type:Organization
Organization Name:BETSY E. WOOD DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:863-368-0538
Mailing Address - Street 1:1100 W STRYKER RD
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-7300
Mailing Address - Country:US
Mailing Address - Phone:863-453-7400
Mailing Address - Fax:863-452-1981
Practice Address - Street 1:1100 W STRYKER RD
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-7300
Practice Address - Country:US
Practice Address - Phone:863-453-7400
Practice Address - Fax:863-452-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8123261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG67085Medicare UPIN