1477583086 NPI number — CHARLES S WINJUM MD

Table of content: CHARLES S WINJUM MD (NPI 1477583086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477583086 NPI number — CHARLES S WINJUM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINJUM
Provider First Name:
CHARLES
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1477583086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 506
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOSSTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56542-0506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-435-1212
Provider Business Mailing Address Fax Number:
218-435-1302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 SATHER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOSSTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56542-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-435-1212
Provider Business Practice Location Address Fax Number:
221-843-5130
Provider Enumeration Date:
07/03/2006

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: 207Q00000X , with the licence number:  31170 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0123282 . This is a "MEDCIA #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: DA9071015707 . This is a "PREFERRED ONE #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: MN100018 . This is a "LHS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 915965 . This is a "AMERICIA'S PPO/ARAZ #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 116153 . This is a "UCARE #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 17708 . This is a "ND MEDICAID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5T073WI . This is a "MNBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 12540 . This is a "NDBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP20444 . This is a "HEALTHPARNTERS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: DA9021015707 . This is a "PREFERRED ONE #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0105958 . This is a "MEDICA #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 054H4WI . This is a "MNBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 26610 . This is a "NDBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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