Provider Demographics
NPI:1821362294
Name:WOODBINE, PC
Entity type:Organization
Organization Name:WOODBINE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TEDI
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CPP-P
Authorized Official - Phone:508-539-6188
Mailing Address - Street 1:5 INDUSTRIAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3464
Mailing Address - Country:US
Mailing Address - Phone:508-477-4282
Mailing Address - Fax:508-539-6134
Practice Address - Street 1:5 INDUSTRIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3464
Practice Address - Country:US
Practice Address - Phone:508-477-4282
Practice Address - Fax:508-539-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51965261QU0200X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care