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General NPI Number Information
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NPI Number | 1588091714
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Entity Type | Organization
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Legal Business Name | WINSTON MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 90 EAST MAIN STREET
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City | NOXAPATER
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State | MS
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Zip | 39346
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Country | US
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Telephone | 662-724-4051
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Fax | 662-724-4054
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Provider Business Mailing Address
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Address Line | PO BOX 470
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City | LOUISVILLE
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State | MS
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Zip | 39339-0470
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Country | US
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Telephone | 662-446-1972
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Fax | 662-446-1039
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Authorized Official
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Title or Position | DIRECTOR OF CLINIC OPERATIONS
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Name | DEBRA J FRYERY
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Credential |
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Telephone | 662-446-1972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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