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General NPI Number Information
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NPI Number | 1265627087
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Entity Type | Organization
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Legal Business Name | FAMILY CARE OF WOODWARD
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 1611 MAIN ST SUITE 203
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City | WOODWARD
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State | OK
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Zip | 73801-3021
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Country | US
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Telephone | 580-256-2900
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Fax | 580-256-3900
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Provider Business Mailing Address
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Address Line | 1611 MAIN ST SUITE 203
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City | WOODWARD
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State | OK
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Zip | 73801-3021
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Country | US
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Telephone | 580-256-2900
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Fax | 580-256-3900
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | JOSEPH BERDECIA
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Credential | MD-PHD
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Telephone | 580-256-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 25220
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License Number State | OK
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