Healthcare Provider Details

I. General information

NPI: 1952354813
Provider Name (Legal Business Name): WINCHESTER MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SHOPPERS DR
WINCHESTER KY
40391-1380
US

IV. Provider business mailing address

475 SHOPPERS DR
WINCHESTER KY
40391-1380
US

V. Phone/Fax

Practice location:
  • Phone: 859-744-5111
  • Fax: 859-744-1177
Mailing address:
  • Phone: 859-744-5111
  • Fax: 859-744-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RALPH A ALVARADO
Title or Position: OWNER
Credential: M.D.
Phone: 859-744-5111