1265871693 NPI number — DR. EMORY SMITH WINSHIP VIII D.O.

Table of content: DR. EMORY SMITH WINSHIP VIII D.O. (NPI 1265871693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265871693 NPI number — DR. EMORY SMITH WINSHIP VIII D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINSHIP
Provider First Name:
EMORY
Provider Middle Name:
SMITH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
VIII
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265871693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NAVAL HOSPITAL CAMP PENDLETON INTERNAL MEDICINE CLINIC
Provider Second Line Business Mailing Address:
200 MERCY CIRCLE
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-725-1213
Provider Business Mailing Address Fax Number:
760-725-1303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAL HOSPITAL CAMP PENDLETON INTERNAL MEDICINE CLINIC
Provider Second Line Business Practice Location Address:
200 MERCY CIRCLE
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-1213
Provider Business Practice Location Address Fax Number:
760-725-1303
Provider Enumeration Date:
06/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  17642 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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