Provider Demographics
NPI:1720008683
Name:WOODIEL, JAMES C (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:WOODIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-1035
Mailing Address - Country:US
Mailing Address - Phone:812-883-1373
Mailing Address - Fax:812-883-5909
Practice Address - Street 1:1002 N SHELBY ST STE 1002
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-2307
Practice Address - Country:US
Practice Address - Phone:812-883-3885
Practice Address - Fax:812-883-5909
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050035A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200204640AMedicaid
IN000000067743OtherANTHEM BCBS
IN080137535OtherRAILROAD MEDICARE
IN200204640AMedicaid
IN1257410001Medicare NSC
IN091250Medicare ID - Type UnspecifiedMEDICARE