Organization
WINSTON MEDICAL CLINIC LLC
Active
Parent organization
WINSTON MEDICAL CLINIC LLC
Other names
Winston Medical Clinic Main Street
Organization subpart
Yes
Provider details
NPI number
Legal business name
WINSTON MEDICAL CLINIC LLC
Authorized official
DEBRA J FRYERY (DIRECTOR OF CLINIC OPERATIONS)
(662) 446-1972
Entity
Organization
Contact information
Practice address
16569 W MAIN ST, LOUISVILLE, MS 39339
(662) 773-5704
(662) 773-9463
Mailing address
16569 W MAIN ST, PO BOX 470, LOUISVILLE, MS 39339-2620
(662) 773-5704
(662) 773-9463
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03335534
—
MS
Enumeration date
05/29/2015
Last updated
08/09/2018
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