Provider Demographics
NPI:1912213836
Name:WOODLAND FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:WOODLAND FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-392-6106
Mailing Address - Street 1:202 AGEE ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2617
Mailing Address - Country:US
Mailing Address - Phone:434-392-6143
Mailing Address - Fax:434-392-3866
Practice Address - Street 1:202 AGEE ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2617
Practice Address - Country:US
Practice Address - Phone:434-392-6143
Practice Address - Fax:434-392-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty