1457329054 NPI number — MICHAEL SCOTT WOODS MD

Table of content: MICHAEL SCOTT WOODS MD (NPI 1457329054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457329054 NPI number — MICHAEL SCOTT WOODS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
MICHAEL
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1457329054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 SAINT MICHAELS DR
Provider Second Line Business Mailing Address:
MEDICAL STAFF OFFICE
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-7601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-820-5227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 SAINT MICHAELS DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-7670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-954-8720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD2005-0673 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1074387 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10024484 . This is a "LOVELACE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2MYPR0070690 . This is a "MOLINA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41880081 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: NM009X08 . This is a "BCBS NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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