Provider Demographics
NPI:1679525810
Name:WOODSTOCK SURGICAL CLINIC, PLC
Entity Type:Organization
Organization Name:WOODSTOCK SURGICAL CLINIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:HODSON
Authorized Official - Last Name:WYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-459-3753
Mailing Address - Street 1:103 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1238
Mailing Address - Country:US
Mailing Address - Phone:540-459-3753
Mailing Address - Fax:540-459-8928
Practice Address - Street 1:103 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1238
Practice Address - Country:US
Practice Address - Phone:540-459-3753
Practice Address - Fax:540-459-8928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00010042747Medicaid
VA76159338OtherWAUSAU GROUP
VA435027OtherANTHEM, GROUP
VA435028OtherANTHEM, DR. CARMAIN
VA266315OtherANTHEM, DR. PULIZZI
VA8563807002OtherDR. CARMAIN, CIGNA
VA2188487002OtherDR. PULIZZ CIGNA
VA00010042747Medicaid
VA435028OtherANTHEM, DR. CARMAIN
VA435027OtherANTHEM, GROUP
VA002649W34Medicare ID - Type UnspecifiedMEDICARE, MELISSA
VA2188487002OtherDR. PULIZZ CIGNA
VAC06934Medicare UPIN