Healthcare Provider Details

I. General information

NPI: 1104025048
Provider Name (Legal Business Name): WINN COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 W LAFAYETTE ST
WINNFIELD LA
71483-3463
US

IV. Provider business mailing address

PO BOX 1288
WINNFIELD LA
71483-1288
US

V. Phone/Fax

Practice location:
  • Phone: 318-648-0375
  • Fax: 318-648-0378
Mailing address:
  • Phone: 318-648-0375
  • Fax: 318-648-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 204738
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: STEVEN XUAN NGUYEN
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 318-648-0375