1366467425 NPI number — DR. WILLIAM RICHARD WINN M.D.

Table of content: DR. WILLIAM RICHARD WINN M.D. (NPI 1366467425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366467425 NPI number — DR. WILLIAM RICHARD WINN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINN
Provider First Name:
WILLIAM
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1366467425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93290-7177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-217-9403
Provider Business Mailing Address Fax Number:
559-636-6395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 W MINERAL KING
Provider Second Line Business Practice Location Address:
KAWEAH DELTA MEDICAL CTR
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-642-2000
Provider Business Practice Location Address Fax Number:
559-735-3058
Provider Enumeration Date:
07/12/2006

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: 207RP1001X , with the licence number:  G 8235 , 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)

  • Identifier: 000G82350 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 77-0460556 . This is a "TAX ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".