Woodward Clinic Company, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

WOODWARD CLINIC COMPANY, LLC

Practice address

1650 Main St
Woodward, OK 73801-3046

Phone

(580) 254-8612

NPI assigned

Jan 23, 2008

Organization subpart

No

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

Authorized official

Name

Jennifer L Jackson

Title

Sr. Director of Provider Enrollment

Phone

(615) 465-3334

Specialties & licenses 5

Addresses

Other identifiers 1

Locations

Practitioners 5

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

• Helen S Chiou, MD

  • Internal Medicine Physician
  • Woodward, OK
  • NPI 1952367179
  NPD (past)
• Grover Len Compton, PA-C

  • Physician Assistant
  • McAlester, OK
  • NPI 1043276694
  NPD (past)
• Julie Anne Huela, PA C

  • Medical Physician Assistant
  • Round Rock, TX
  • NPI 1225021058
  NPD (past)
• Rajen Anil Mehta, D.O.

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1831352590
  NPD (past)
• Dorian K Shevitz, PA-C

  • Physician Assistant
  • Georgetown, TX
  • NPI 1780658930
  NPD (past)

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

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1912184755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 COMMERCE WAY",
            "address_2": "SUITE 180",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370272829",
            "telephone_number": "615-465-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 MAIN ST",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738013046",
            "telephone_number": "580-254-8612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODWARD CLINIC COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-23",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR. DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-3334"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200136030",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randal Willis, RPH
• Melissa Ann Wilson
• Kaitlyn Woodard, PARA PROFFESIONAL
• Michael Woods, PHARMD
• Ray Woods
• Woodward County Emergency Medical Service
• Woodward Family Medicine, PLLC
• Woodward Foot Clinic PLLC
• Woodward Health System LLC
• Woodward Health System LLC

• Surgery Physician in Woodward, OK
• Providers in Woodward, OK by specialty
• Surgery Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.