MEDICARE: WOODWORTH FAMILY MEDICINE INC.

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	261QR1300X	Rural Health Clinic/Center	119	LA

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

General Provider Information

NPI Number	:	1639368335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODWORTH FAMILY MEDICINE INC.

Provider Business Mailing Address
First Line	:	P.O.BOX406
Second Line	:
City	:	WOODWORTH
State	:	LA
Zip	:	71485
Country	:	US
Telephone Number	:	318-484-9588
Fax Number	:	318-484-9590

Provider Business Practice Location Address
First Line	:	9372 HWY.165 SOUTH
Second Line	:
City	:	WOODWORTH
State	:	LA
Zip	:	71485
Country	:	US
Telephone Number	:	318-484-9588
Fax Number	:	318-484-9590

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID VANMOL
Credential	:
Telephone Number	:	318-484-9588

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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