1316359961 NPI number — WINFORD BROWN RAMSEUR & ASSOC

Table of content: (NPI 1316359961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316359961 NPI number — WINFORD BROWN RAMSEUR & ASSOC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINFORD BROWN RAMSEUR & ASSOC
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:
1316359961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4680 BROWNSBORO RD # D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27106-3428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-896-9771
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28677-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-223-2084
Provider Business Practice Location Address Fax Number:
336-464-2071
Provider Enumeration Date:
05/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WINFORD
Authorized Official First Name:
LATRINA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
336-896-9771

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MHL-034-265 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1306036470 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629313051 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1780865535 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205972205 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1952535858 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1366654329 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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