NPIMap

Organization Active NPI

Woodstock Medical & Surgical Center, LTD

  • Podiatric Clinic/Center
  • Woodstock, IL
National Provider Identifier
1801098314
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
Legal business name
WOODSTOCK MEDICAL & SURGICAL CENTER, LTD
Practice address
1666 S Eastwood Dr
Woodstock, IL 60098-4655
Phone
(815) 334-8100
Fax
(815) 338-7105
NPI assigned
Jun 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kevin Sean Gavin, D.P.M.
Title
Owner
Phone
(847) 458-1800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatric Clinic/Center 261QP1100X Primary

Addresses

Primary practice location

1666 S Eastwood Dr
Woodstock, IL 60098-4655

Mailing address

PO Box 683
Woodstock, IL 60098-0683
Phone (815) 334-8100

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801098314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 683",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600980683",
            "telephone_number": "815-334-8100",
            "fax_number": "815-338-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1666 S EASTWOOD DR",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600984655",
            "telephone_number": "815-334-8100",
            "fax_number": "815-338-7105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODSTOCK MEDICAL & SURGICAL CENTER, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "SEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "18474581800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.