1063465524 NPI number — JOHN D. WOODY, MD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063465524 NPI number — JOHN D. WOODY, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN D. WOODY, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063465524
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 863258
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32886-3258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-496-3581
Provider Business Mailing Address Fax Number:
844-876-0873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3340 LAKELAND HILLS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33805-1974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-614-9863
Provider Business Practice Location Address Fax Number:
844-876-0873
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOODY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
MD/PRESIDENT
Authorized Official Telephone Number:
317-614-9863

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 273664100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38562 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DD6609 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273664100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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