| Winston Medical Clinic Llc | |
|
90 East Main Street Noxapater MS 39346 | |
| (662) 724-4051 | |
| (662) 724-4054 |
| Full Name | Winston Medical Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 90 East Main Street, Noxapater, 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 |
|---|---|
| Winston Medical Clinic Llc Po Box 470 Louisville MS 39339-0470 Ph: (662) 446-1972 | Winston Medical Clinic Llc 90 East Main Street Noxapater MS 39346 Ph: (662) 724-4051 |
| NPI Number | 1588091714 |
|---|---|
| Provider Enumeration Date | 10/02/2013 |
| Last Update Date | 02/09/2017 |
| Medicare PECOS PAC ID | 7214170968 |
|---|---|
| Medicare Enrollment ID | O20140124001251 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588091714 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Michael L Ard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962484899 PECOS PAC ID: 2365523875 Enrollment ID: I20080122000693 |
| Provider Name | Heather M Gilmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477706323 PECOS PAC ID: 3678638509 Enrollment ID: I20090210000264 |