Provider Demographics
NPI:1740362003
Name:WOODHOUSE MEDICAL CLINIC P.C.
Entity type:Organization
Organization Name:WOODHOUSE MEDICAL CLINIC P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY-LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNST-WOODHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-832-3332
Mailing Address - Street 1:903 WILLSON AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-2214
Mailing Address - Country:US
Mailing Address - Phone:515-832-3332
Mailing Address - Fax:515-832-1114
Practice Address - Street 1:903 WILLSON AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2214
Practice Address - Country:US
Practice Address - Phone:515-832-3332
Practice Address - Fax:515-832-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03200207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1183889Medicaid
IAI8590Medicare ID - Type Unspecified
IA1183889Medicaid