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General NPI Number Information
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NPI Number | 1275924441
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Entity Type | Organization
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Legal Business Name | WOOD HEALTH CARE CLINIC LAB
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 1307 LAFAYETTE AVE
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City | MOUNDSVILLE
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State | WV
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Zip | 26041-2316
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Country | US
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Telephone | 304-845-2893
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Fax | 304-845-2624
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Provider Business Mailing Address
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Address Line | 1307 LAFAYETTE AVE
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City | MOUNDSVILLE
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State | WV
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Zip | 26041-2316
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Country | US
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Telephone | 304-845-2893
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Fax | 304-845-2624
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY K WOOD
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Credential | D.O.
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Telephone | 304-845-2893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 51D0235758
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License Number State | WV
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