Provider Demographics
NPI:1841490174
Name:NEIL LIPSCOMB WOOD, JR, MD, INC.
Entity type:Organization
Organization Name:NEIL LIPSCOMB WOOD, JR, MD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:LIPSCOMB
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:530-888-6322
Mailing Address - Street 1:11985 HERITAGE OAK PL
Mailing Address - Street 2:#220
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2461
Mailing Address - Country:US
Mailing Address - Phone:530-888-6322
Mailing Address - Fax:530-888-6338
Practice Address - Street 1:11985 HERITAGE OAK PL
Practice Address - Street 2:#220
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2461
Practice Address - Country:US
Practice Address - Phone:530-888-6322
Practice Address - Fax:530-888-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36813261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty