1992837330 NPI number — LLOYD P VAN WINKLE, MD, PA

Table of content: (NPI 1992837330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992837330 NPI number — LLOYD P VAN WINKLE, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LLOYD P VAN WINKLE, MD, PA
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:
MEDINA VALLEY FAMILY PRACTICE
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:
1992837330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/15/2008
NPI Reactivation Date:
10/07/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 MADRID ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASTROVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78009-4527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-538-2254
Provider Business Mailing Address Fax Number:
830-931-2259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 MADRID ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTROVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78009-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-538-2254
Provider Business Practice Location Address Fax Number:
830-931-2259
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VAN WINKLE
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER/S CORPORATION
Authorized Official Telephone Number:
830-538-2254

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  G3878 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45D0498955 . This is a "CLIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 142464002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142464001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: TXB104619 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: R14737 . This is a "RADIATION CONTROL ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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