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General NPI Number Information
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NPI Number | 1780846493
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Entity Type | Organization
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Legal Business Name | WINDSOR FAMILY MEDICAL CLINIC INC
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 114 N MAIN ST
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City | WINDSOR
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State | MO
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Zip | 65360-1355
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Country | US
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Telephone | 660-647-2111
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Fax | 660-647-2110
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Provider Business Mailing Address
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Address Line | PO BOX 107
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City | WINDSOR
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State | MO
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Zip | 65360-0107
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Country | US
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Telephone | 660-647-2111
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Fax | 660-647-2110
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. GEORGE E WINDSOR
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Credential | D.O.
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Telephone | 660-647-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 26D0721157
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License Number State | MO
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