Healthcare Provider Details

I. General information

NPI: 1164410973
Provider Name (Legal Business Name): WOOD COUNTY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 W WOOSTER SUITE 130
BOWLING GREEN OH
43402
US

IV. Provider business mailing address

970 W WOOSTER SUITE 130
BOWLING GREEN OH
43402
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-5899
  • Fax: 419-353-2415
Mailing address:
  • Phone: 419-352-5899
  • Fax: 419-353-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LEMON
Title or Position: PRESIDENT
Credential: MD
Phone: 419-352-5899