Organization
WINSTON MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE J FRYERY (DIRECTOR OF CLINIC OPERATIONS)
(662) 446-1972
Entity
Organization
Contact information
Practice address
923 S CHURCH AVE, LOUISVILLE, MS 39339
(662) 773-3503
(662) 446-1039
Mailing address
P O BOX 470, LOUISVILLE, MS 39339
(662) 773-3503
(662) 446-1039
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01689827
—
MS
Enumeration date
06/17/2013
Last updated
01/19/2017
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