=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053547547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUE M WOOD, M.D. INC., P.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2009
-----------------------------------------------------
Last Update Date | 06/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9714 3RD AVE NE SUITE 103
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98115-2044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-362-4141
-----------------------------------------------------
Fax | 206-365-0926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9714 3RD AVE NE SUITE 103
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98115-2044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-362-4141
-----------------------------------------------------
Fax | 206-365-0926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL BILLING CONTRACTOR
-----------------------------------------------------
Name | LAURA SANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-362-4141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD00011229
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------