MEDICARE: WINNIE COMMUNITY HOSPITAL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician
3	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1316623481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINNIE COMMUNITY HOSPITAL LLC

Provider Business Mailing Address
First Line	:	538 BROADWAY
Second Line	:
City	:	WINNIE
State	:	TX
Zip	:	77665-7600
Country	:	US
Telephone Number	:	409-296-6000
Fax Number	:	409-296-6372

Provider Business Practice Location Address
First Line	:	2400 HIGHWAY 365 STE 208
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-6250
Country	:	US
Telephone Number	:	409-724-7904
Fax Number	:	409-226-3374

Authorized Official
Title or Position	:	CEO
Name	:	MR. M. TAHIR JAVED
Credential	:
Telephone Number	:	409-730-8054

Provider Enumeration Date	:	06/23/2023
Last Update Date	:	07/10/2023

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Directions to “WINNIE COMMUNITY HOSPITAL LLC ” Practice Location

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