1841490174 NPI number — NEIL LIPSCOMB WOOD, JR, MD, INC.

Table of content: (NPI 1841490174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841490174 NPI number — NEIL LIPSCOMB WOOD, JR, MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIL LIPSCOMB WOOD, JR, MD, INC.
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:
6
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:
1841490174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11985 HERITAGE OAK PL
Provider Second Line Business Mailing Address:
#220
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95603-2461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-888-6322
Provider Business Mailing Address Fax Number:
530-888-6338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11985 HERITAGE OAK PL
Provider Second Line Business Practice Location Address:
#220
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-888-6322
Provider Business Practice Location Address Fax Number:
530-888-6338
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOOD
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
LIPSCOMB
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
530-888-6322

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  C36813 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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