Provider Demographics
NPI:1740371558
Name:WOOD FAMILY MEDICINE, P.C.
Entity type:Organization
Organization Name:WOOD FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-775-3857
Mailing Address - Street 1:409 E REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-3018
Mailing Address - Country:US
Mailing Address - Phone:918-775-3857
Mailing Address - Fax:918-775-0587
Practice Address - Street 1:409 E REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-3018
Practice Address - Country:US
Practice Address - Phone:918-775-3857
Practice Address - Fax:918-775-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200004670AMedicaid
OK248311603OtherOK BC/BS GROUP NUMBER
OK200004670AMedicaid
OK800522243Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER