Provider Demographics
NPI:1003015231
Name:NWMC-WINFIELD PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:NWMC-WINFIELD PHYSICIAN PRACTICES LLC
Other - Org Name:NORTHWEST SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANORD
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:205-487-7800
Mailing Address - Street 1:255 MEDICAL DRIVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594
Mailing Address - Country:US
Mailing Address - Phone:205-487-7800
Mailing Address - Fax:205-487-7614
Practice Address - Street 1:255 MEDICAL DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594
Practice Address - Country:US
Practice Address - Phone:205-487-7800
Practice Address - Fax:205-487-7614
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NWMC-WINFIELD PHYSICIAN PRACTICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-17
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23436208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529932829Medicaid
ALDG4823OtherRAILROAD MEDICARE
AL529932829Medicaid