Organization
WOODWARD CLINIC COMPANY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR. DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-3334
Entity
Organization
Contact information
Practice address
1650 MAIN ST, WOODWARD, OK 73801-3046
(580) 254-8612
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
(615) 465-7000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208600000X
Surgery Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200136030
—
OK
Enumeration date
01/23/2008
Last updated
10/01/2021
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