Provider Demographics
NPI:1013940956
Name:WOOD, ERIC R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:R
Last Name:WOOD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-0801
Practice Address - Country:US
Practice Address - Phone:859-655-1100
Practice Address - Fax:859-655-1102
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1045363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9500517900Medicaid
KY7100056850Medicaid
P00424232OtherRAILROAD MEDICARE
OHWOPA24344OtherOH MEDICARE
KY9500517900Medicaid
KY7100056850Medicaid
P00424232Medicare PIN
KYP00424232Medicare PIN
KY1459521Medicare PIN