1346233640 NPI number — BERNARD WILLIAM SIMIERITSCH

Table of content: (NPI 1346233640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346233640 NPI number — BERNARD WILLIAM SIMIERITSCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERNARD WILLIAM SIMIERITSCH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WINSTON COUNTY MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
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:
1346233640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15341 HIGHWAY 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUBLE SPRINGS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35553-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-489-3322
Provider Business Mailing Address Fax Number:
205-489-3325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15341 HIGHWAY 278
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOUBLE SPRINGS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35553-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-489-3322
Provider Business Practice Location Address Fax Number:
205-489-3325
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SIMIERITSCH
Authorized Official First Name:
BERNARD
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-489-3322

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 051550393 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 541003924 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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