Healthcare Provider Details

I. General information

NPI: 1770828444
Provider Name (Legal Business Name): WOODWARD HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HILLCREST DR
WOODWARD OK
73801-3027
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 580-256-3608
  • Fax: 580-256-3624
Mailing address:
  • Phone: 800-709-7338
  • Fax: 615-465-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: BRIAN A PEOPLES
Title or Position: VP PHYSICIAN OPERATIONS
Credential:
Phone: 615-465-7585