1225118474 NPI number — WOODLAND HEALTHCARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225118474 NPI number — WOODLAND HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODLAND HEALTHCARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WOODLAND HEALTHCARE SURGICENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225118474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8865 W 400 N STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MICHIGAN CITY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46360-9223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-877-2222
Provider Business Mailing Address Fax Number:
219-877-2220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8865 W 400 N STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MICHIGAN CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46360-9223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-877-2222
Provider Business Practice Location Address Fax Number:
219-877-2220
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THORDARSON
Authorized Official First Name:
G
Authorized Official Middle Name:
THOR
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
219-877-2222

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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