Provider Demographics
NPI:1265469530
Name:WINONA HEALTH SERVICES
Entity Type:Organization
Organization Name:WINONA HEALTH SERVICES
Other - Org Name:WINONA HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISING-SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:507-454-3650
Mailing Address - Street 1:855 MANKATO AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987
Mailing Address - Country:US
Mailing Address - Phone:507-454-4925
Mailing Address - Fax:507-494-5717
Practice Address - Street 1:930 PARKS AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5325
Practice Address - Country:US
Practice Address - Phone:507-457-7703
Practice Address - Fax:507-494-5717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MN2603073336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2046419OtherPK
WI33060700Medicaid
MN635059300Medicaid
1220750001Medicare NSC
MN635059300Medicaid