Winston Medical Clinic Main Street | |
16569 W Main St Louisville MS 39339 | |
(662) 773-5704 | |
(662) 773-9463 |
Full Name | Winston Medical Clinic Main Street |
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Speciality | Clinic/Center |
Location | 16569 W Main St, Louisville, Mississippi |
Authorized Official Name and Position | Debra J Fryery (DIRECTOR OF CLINIC OPERATIONS) |
Authorized Official Contact | 6624461972 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Winston Medical Clinic Main Street 16569 W Main St Po Box 470 Louisville MS 39339-2620 Ph: (662) 773-5704 | Winston Medical Clinic Main Street 16569 W Main St Louisville MS 39339 Ph: (662) 773-5704 |
NPI Number | 1033598503 |
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Provider Enumeration Date | 05/29/2015 |
Last Update Date | 08/09/2018 |
Medicare PECOS PAC ID | 7214170968 |
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Medicare Enrollment ID | O20170713001264 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033598503 | NPI | - | NPPES |
03335534 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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