Woodruff Family Medical Clinic, Llc | |
311 W Main St Wilburton OK 74578-4047 | |
(918) 465-0001 | |
(918) 465-0003 |
Full Name | Woodruff Family Medical Clinic, Llc |
---|---|
Speciality | Family Medicine |
Location | 311 W Main St, Wilburton, Oklahoma |
Authorized Official Name and Position | Robert A. Woodruff (OWNER/PHYSICIAN) |
Authorized Official Contact | 9184650001 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Woodruff Family Medical Clinic, Llc 311 W Main St Wilburton OK 74578-4047 Ph: (918) 465-0001 | Woodruff Family Medical Clinic, Llc 311 W Main St Wilburton OK 74578-4047 Ph: (918) 465-0001 |
NPI Number | 1235570938 |
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Provider Enumeration Date | 07/10/2013 |
Last Update Date | 03/17/2014 |
Medicare PECOS PAC ID | 5890921936 |
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Medicare Enrollment ID | O20131120001514 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235570938 | NPI | - | NPPES |
100749100A | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 2209 (Oklahoma) | Primary |
Provider Name | Robert A Woodruff |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1073554754 PECOS PAC ID: 7517968589 Enrollment ID: I20100810001077 |
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