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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1700953965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODWORTH FAMILY MEDICINE INC.

Provider Business Mailing Address
First Line	:	PO BOX 406
Second Line	:
City	:	WOODWORTH
State	:	LA
Zip	:	71485-0406
Country	:	US
Telephone Number	:	318-484-9588
Fax Number	:	318-484-9590

Provider Business Practice Location Address
First Line	:	9372 HWY. 165 S.
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	:	OFFICE MANAGER
Name	:	CHRISTINA R. DAVISON
Credential	:
Telephone Number	:	318-484-9588

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	10/11/2007

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