MEDICARE: WINSTON COUNTY MEDICAL FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	16-208	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CA9070	OTHER	MS	RAILROAD MEDICARE
6	CC0523	OTHER	MS	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19155	OTHER	MS	BLUE CROSS ERP
2	C02067	OTHER	MS	CAHABA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	C00158	OTHER	MS	CAHABA

General Provider Information

NPI Number	:	1316078108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINSTON COUNTY MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 967
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-0967
Country	:	US
Telephone Number	:	662-773-6211
Fax Number	:	662-773-6223

Provider Business Practice Location Address
First Line	:	17550 E MAIN ST
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-2772
Country	:	US
Telephone Number	:	662-773-6211
Fax Number	:	662-446-1039

Authorized Official
Title or Position	:	CONTROLLER
Name	:	JAMES MATTHEW WOODWARD
Credential	:
Telephone Number	:	662-446-1072

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	12/10/2019

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Directions to “WINSTON COUNTY MEDICAL FOUNDATION ” Practice Location

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