WOODSIDE MEDICAL GROUP, INC. (NPI# 1821148404) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821148404 |
| Entity Type | Organization |
| Organization Name | WOODSIDE MEDICAL GROUP, INC. |
| Practice Address |
475 Lexington Ave Mansfield OH 44907-1501 |
| Practice Telephone | 4197562003 |
| Practice Fax Number | 4197563637 |
| Mailing Telephone | 4197562003 |
| Mailing Fax Number | 4197563637 |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2011-10-04 |
| Authorized Official Name | DR. ROBERT EDWIN EXTEN JR. (PRES) |
| Authorized Official Telephone | 4197562003 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QI0500X |
Clinic/Center Specialization: Infusion Therapy |
Ambulatory Health Care Facilities | ||
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
| Street Address |
475 LEXINGTON AVE |
| City | MANSFIELD |
| State | OH |
| Zip Code | 44907-1501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205832375 | Robert Edwin Exten Jr. | Internal Medicine | 475 Lexington Ave, Mansfield, OH 44907-1501 | 2005-06-23 |
| 1528687589 | Lorrie L. Hedrick | Counselor | 475 Lexington Ave, Mansfield, OH 44907-1501 | 2020-04-10 |
| 1164041125 | Alissa R Keysor | Licensed Practical Nurse | 475 Lexington Ave, Mansfield, OH 44907-1501 | 2020-04-10 |
| 1013579234 | Shaunqua S Crawford | Licensed Practical Nurse | 475 Lexington Ave, Mansfield, OH 44907-1501 | 2019-07-09 |
| 1184053100 | Tammy Canfield | Nurse Practitioner | 475 Lexington Ave, Mansfield, OH 44907-1501 | 2013-11-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053932434 | Kerri Nichole Tolliver | Licensed Practical Nurse | Mansfield Comprehensive Treatment Center, 475 Lexington Ave, Mansfield, OH 44907 | 2020-04-27 |
| 1790325371 | Gabrielle Smith | Licensed Practical Nurse | 707 Scholl Rd, Mansfield, OH 44907 | 2020-01-10 |
| 1912544982 | Heidi L Mathews | Behavior Technician | 270 Sterkel Blvd., Mansfield, OH 44907 | 2019-12-09 |
| 1851942254 | Misty J Kline | Licensed Practical Nurse | 707 Scholl Rd., Mansfield, OH 44907 | 2019-09-26 |
| 1528533320 | Ohio Treatment Center, LLC | Clinic/Center | 475 Lexington Ave., Mansfield, OH 44907 | 2018-10-08 |
| 1750898722 | Hannah Rose Hardin | Behavior Technician | 1033 Larchwood R, Mansfield, OH 44907 | 2017-12-29 |
| 1932548856 | Jessica Alexis Taylor | Counselor | 641 Scholl Rd., Mansfield, OH 44907 | 2013-06-25 |
| 1336495258 | Sonal Sinha | Psychiatry & Neurology | 341 Cline Ave Ste 1, Mansfield, OH 44907 | 2012-07-29 |
| 1427321579 | Tara Kightlinger | Community Health Worker | 442 Brenda Dr, Mansfield, OH 44907 | 2012-02-21 |
| 1649557620 | William Scott Olar | Chiropractor | 1179 Lexington Ave, Mansfield, OH 44907 | 2011-11-04 |
| Find all providers in zip 44907 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
| 1982945127 | Hospitalist Partners of Excellence In Mansfield (h.o.p.e), P.a. | Clinic/Center | 2800 E Broad St, Suite 308, Mansfield, TX 76063-6412 | 2013-03-13 |
| 1164652822 | Mid Ohio Infectious Diseases Clinic LLC | Clinic/Center | 630 Lexington Ave, Mansfield, OH 44907-1500 | 2009-07-16 |
| 1417191636 | Mansfield Plastic Surgery, LLC | Clinic/Center | 370 Cline Ave, Mansfield, OH 44907-1057 | 2009-05-01 |
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| 1275927840 | Alliance Recovery Specialists LLC | Clinic/Center | 2371 W State St, Suite A, Alliance, OH 44601-3594 | 2015-03-23 |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.