MEDICARE: AMBER WOODFIELD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA00801	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8N3961	OTHER	TX	BCBS OF TEXAS

General Provider Information

NPI Number	:	1104828433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER WOODFIELD PA

Provider Business Mailing Address
First Line	:	4101 WESLEY ST
Second Line	:	STE C
City	:	GREENVILLE
State	:	TX
Zip	:	75401-5635
Country	:	US
Telephone Number	:	903-454-8111
Fax Number	:	903-454-1680

Provider Business Practice Location Address
First Line	:	4101 WESLEY ST
Second Line	:	STE C
City	:	GREENVILLE
State	:	TX
Zip	:	75401-5635
Country	:	US
Telephone Number	:	903-454-8111
Fax Number	:	903-454-1680

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/09/2020

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Directions to “ AMBER WOODFIELD PA” Practice Location

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