Healthcare Provider Details

I. General information

NPI: 1386057792
Provider Name (Legal Business Name): KENNETH EUGENE WOOD JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N WASHINGTON AVE
CHANUTE KS
66720
US

IV. Provider business mailing address

215 N WASHINGTON AVE
CHANUTE KS
66720-1651
US

V. Phone/Fax

Practice location:
  • Phone: 620-431-1908
  • Fax:
Mailing address:
  • Phone: 620-431-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberSAVE
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: