Healthcare Provider Details

I. General information

NPI: 1972845295
Provider Name (Legal Business Name): NWMC-WINFIELD PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CARRAWAY DR SUITE 2
WINFIELD AL
35594-5048
US

IV. Provider business mailing address

200 CARRAWAY DR SUITE 2
WINFIELD AL
35594-5048
US

V. Phone/Fax

Practice location:
  • Phone: 205-487-7000
  • Fax:
Mailing address:
  • Phone: 205-487-7000
  • Fax: 205-487-7666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGIE MANGUM
Title or Position: SENIOR DIRECTOR-PHYSICIAN SERVICE
Credential:
Phone: 615-565-1898