Healthcare Provider Details

I. General information

NPI: 1528454022
Provider Name (Legal Business Name): WINN-THRID PARTY INSURANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1746 WILLIAM H. WILSON AVE
FORT STEWART GA
31314
US

IV. Provider business mailing address

1061 HARMON AVE STE 1D03
FORT STEWART GA
31314-5641
US

V. Phone/Fax

Practice location:
  • Phone: 912-435-6633
  • Fax:
Mailing address:
  • Phone: 912-435-6037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HENRY FORD
Title or Position: UBO MANAGER
Credential:
Phone: 912-435-6175