Healthcare Provider Details

I. General information

NPI: 1780621326
Provider Name (Legal Business Name): WINNSBORO MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3326 FRONT ST SUITE B
WINNSBORO LA
71295-6487
US

IV. Provider business mailing address

3326 FRONT ST SUITE B
WINNSBORO LA
71295-6487
US

V. Phone/Fax

Practice location:
  • Phone: 318-435-7333
  • Fax: 318-435-9061
Mailing address:
  • Phone: 318-435-7333
  • Fax: 318-435-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES E REED
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 318-435-7333