Healthcare Provider Details

I. General information

NPI: 1679525810
Provider Name (Legal Business Name): WOODSTOCK SURGICAL CLINIC, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W SOUTH ST
WOODSTOCK VA
22664-1238
US

IV. Provider business mailing address

103 W SOUTH ST
WOODSTOCK VA
22664-1238
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-3753
  • Fax: 540-459-8928
Mailing address:
  • Phone: 540-459-3753
  • Fax: 540-459-8928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HOLLY HODSON WYMER
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 540-459-3753