MEDICARE: THOMAS C. WOOLDRIDGE A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	13859	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770794604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS C. WOOLDRIDGE A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1921 NORTH WASHINGTON ST.
Second Line	:	P. O. BOX 1640
City	:	BASTROP
State	:	LA
Zip	:	71221-1640
Country	:	US
Telephone Number	:	318-283-0400
Fax Number	:	318-283-0400

Provider Business Practice Location Address
First Line	:	1921 NORTH WASHINGTON ST.
Second Line	:
City	:	BASTROP
State	:	LA
Zip	:	71221-1640
Country	:	US
Telephone Number	:	318-283-0400
Fax Number	:	318-283-0400

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	DR. THOMAS CLAYTON WOOLDRIDGE
Credential	:	M.D.
Telephone Number	:	318-283-0400

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/14/2014

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