Healthcare Provider Details

I. General information

NPI: 1457514937
Provider Name (Legal Business Name): KENNETH LEE WOODS II DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2008
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHNSON RD STE 202
STEUBENVILLE OH
43952-2372
US

IV. Provider business mailing address

380 SUMMIT AVE MSO PHYSICIAN BILLING
STEUBENVILLE OH
43952-2667
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-8537
  • Fax: 740-346-2024
Mailing address:
  • Phone: 740-283-7597
  • Fax: 740-283-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number010221
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS015559
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number34010221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: