Woodman Primary Care LLC

Primary specialty

Medical Toxicology (Preventive Medicine) PhysicianTaxonomy code 2083T0002X

License

36D2087191 Issued in OH

Legal business name

WOODMAN PRIMARY CARE LLC

Practice address

1320 Woodman Dr
Dayton, OH 45432-3497

Phone

(937) 223-1781

Fax

(937) 424-8656

NPI assigned

Feb 1, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeffrey F Kolaczkowski, MSWNPI 1821070137

Title

Director

Phone

(937) 272-5926

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey Frank Kolaczkowski, MSW LISW LCSW

  • Clinical Social Worker
  • Dayton, OH
  • NPI 1821070137
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517443200000",
    "number": "1245738541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 WOODMAN DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454323497",
            "telephone_number": "937-223-1781",
            "fax_number": "937-424-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 WOODMAN DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454323497",
            "telephone_number": "937-223-1781",
            "fax_number": "937-424-8656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODMAN PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-01",
        "last_updated": "2018-02-01",
        "status": "A",
        "authorized_official_last_name": "KOLACZKOWSKI",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "937-272-5926",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "2083T0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Medical Toxicology",
            "state": "OH",
            "license": "36D2087191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charmaine Blake Woode, MD
• Issac James Woodfork
• Wilma Nannette Woodfork
• Valerie Ann Woodley, RN-BSN
• Woodman Pharmacy
• Woodman Primary Care LLC
• Kercelia Woodruff
• Sabra Woodruff, RPH
• Sydney Woodruff
• Vincent Stuart Woodruff

• Medical Toxicology (Preventive Medicine) Physician in Dayton, OH
• Providers in Dayton, OH by specialty
• Medical Toxicology (Preventive Medicine) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.