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Organization
WOODSIDE MEDICAL GROUP, INC.
Active
Organization
WOODSIDE MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT EDWIN EXTEN JR. MD (PRES)
(419) 756-2003
Entity
Organization
Contact information
Practice address
475 LEXINGTON AVE, MANSFIELD, OH 44907-1501
(419) 756-2003
(419) 756-3637
Mailing address
475 LEXINGTON AVE, MANSFIELD, OH 44907-1501
(419) 756-2003
(419) 756-3637
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
—
NULL
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
01/12/2007
Last updated
10/04/2011
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