Dr Robert Woodruff DPM PA
Organization Active NPI Foot Surgery Podiatrist · Bolton, MS
NPI 1083882385 · NPPES record last updated Sep 14, 2021
Key facts
- NPI
- 1083882385
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Foot Surgery Podiatrist 213ES0131X
- License
- 80102 (MS)
- Legal business name
- DR ROBERT WOODRUFF DPM PA
- Practice address
- 1055 Hubb Rd
Bolton, MS 39041-8500 - Phone
- (601) 506-7400
- NPI assigned
- Feb 20, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Robert Woodruff, DPM
- Title
- Ceo
- Phone
- (601) 506-7400
Practitioners 1
-
Robert Kelvin Woodruff, D.P.M., P.A.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080430000267 | MS | Part B Supplier - Clinic/Group Practice | 5092894261 |
Receives reassigned benefits from 1 practitioner Practice locations: Bolton, MS |
National Provider Directory
Locations
3855 Azalea Dr
Jackson, MS 39206
Phone (601) 366-7063
311 W Main St
Wilburton, OK 74578
Phone (918) 465-0001
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot Surgery Podiatrist |
213ES0131X | 80102 | MS | Yes |
Addresses
Primary practice location
1055 Hubb Rd
Bolton, MS 39041-8500
Mailing address
1055 Hubb Rd
Bolton, MS 39041-8500
Phone (601) 506-7400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0110072 | Medicaid | MS |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | podiatryassociat@aol.com | Health Information Exchange (HIE) | |
| CONNECT URL | podiatryassociat@aol.com | Health Information Exchange (HIE) |
Other providers in Bolton, MS
- Bolton Edwards Elementary Middle School
- Robin L Bolton
- Coleman A. Boyd
- Caring Hands Touch of Care
- Central Mississippi Civic Improvement Association, Inc
- Janet Gray
- Health Wellness Promotion LLC
- Lisa Byrd Healthcare Inc
- Lisa Byrd Healthcare Inc
- Jean Pennington Marks
All providers in Bolton, MS · Foot Surgery Podiatrist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.