1780846493 NPI number — WINDSOR FAMILY MEDICAL CLINIC INC

Table of content: (NPI 1780846493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780846493 NPI number — WINDSOR FAMILY MEDICAL CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDSOR FAMILY MEDICAL CLINIC INC
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:
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:
1780846493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDSOR
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65360-0107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-647-2111
Provider Business Mailing Address Fax Number:
660-647-2110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65360-1355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-647-2111
Provider Business Practice Location Address Fax Number:
660-647-2110
Provider Enumeration Date:
06/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WINDSOR
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
660-647-2111

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  26D0721157 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000328280 . This is a "FAMILY HEALTH PARTNERS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1184625139 . This is a "TYPE 1 NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 240252908 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00456003 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 33420 . This is a "HCUSA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7904 . This is a "MERCY CARE PLUS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 05245011 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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