Healthcare Provider Details

I. General information

NPI: 1205423308
Provider Name (Legal Business Name): LANCE ERIC WOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 CLEVELAND AVE
COLUMBUS OH
43231-2208
US

IV. Provider business mailing address

5925 CLEVELAND AVE
COLUMBUS OH
43231-2208
US

V. Phone/Fax

Practice location:
  • Phone: 614-776-4646
  • Fax:
Mailing address:
  • Phone: 614-776-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2513255
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: