1952453813 NPI number — DR. GEORGE STEPHEN WOOD O D

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952453813 NPI number — DR. GEORGE STEPHEN WOOD O D

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WOOD

Provider First Name:

GEORGE

Provider Middle Name:

STEPHEN

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

O D

Provider Gender Code:

M

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:

1952453813

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/14/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

609 WEST MAIN ST

Provider Second Line Business Mailing Address:

PO BOX 100

Provider Business Mailing Address City Name:

POWDERLY

Provider Business Mailing Address State Name:

KY

Provider Business Mailing Address Postal Code:

42367-0100

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

270-338-4091

Provider Business Mailing Address Fax Number:

270-338-7913

Provider First Line Business Practice Location Address:

609 WEST MAIN ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

POWDERLY

Provider Business Practice Location Address State Name:

KY

Provider Business Practice Location Address Postal Code:

42367-0100

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

270-338-4091

Provider Business Practice Location Address Fax Number:

270-338-7913

Provider Enumeration Date:

01/18/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  1033 DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0005070459 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 24916 . This is a "AVESIS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: C 9226901 . This is a "UNITED AMERICAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 000000218896 . This is a "ANTHEM BC-BS OF KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: KY 1033 . This is a "EYEMED" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 379358 . This is a "COMBINED INS. CO. OF AMER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 77010338 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: KY01944861 . This is a "FUNDS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: XXXX7992 42367 0000 . This is a "TRICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 051905000073 . This is a "HEALTHSCOPE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 96600 . This is a "SPECTERA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".