Provider Demographics
NPI:1184772568
Name:OAKWOOD CLINIC FAMILY PRACTICE INC
Entity type:Organization
Organization Name:OAKWOOD CLINIC FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:WACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:304-242-3550
Mailing Address - Street 1:616 FAIRMONT PIKE RT 88
Mailing Address - Street 2:PO BOX 2286
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-242-3500
Mailing Address - Fax:304-242-5810
Practice Address - Street 1:616 FAIRMONT PIKE RT88
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-242-3550
Practice Address - Fax:304-242-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0009097000Medicaid
A71984Medicare UPIN
WV0009097000Medicaid