Provider Demographics
NPI:1801098314
Name:WOODSTOCK MEDICAL & SURGICAL CENTER, LTD
Entity type:Organization
Organization Name:WOODSTOCK MEDICAL & SURGICAL CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:1847-458-1800
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-0683
Mailing Address - Country:US
Mailing Address - Phone:815-334-8100
Mailing Address - Fax:815-338-7105
Practice Address - Street 1:1666 S EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-4655
Practice Address - Country:US
Practice Address - Phone:815-334-8100
Practice Address - Fax:815-338-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric