1053476010 NPI number — STEVEN PAUL WINKLER M D

Table of content: (NPI 1053476010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053476010 NPI number — STEVEN PAUL WINKLER M D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN PAUL WINKLER M D
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:
Provider Other Organization Name Type Code:
6
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:
1053476010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50823
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89016-0823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-617-8684
Provider Business Mailing Address Fax Number:
702-617-2560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10001 S EASTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-3907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-617-8684
Provider Business Practice Location Address Fax Number:
702-617-2560
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WINKLER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
702-617-8684

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  7842 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002019984 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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