Provider Demographics
NPI:1285649855
Name:TYLER HOLMES MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:TYLER HOLMES MEMORIAL HOSPITAL
Other - Org Name:WINONA FMAILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEMORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-283-6119
Mailing Address - Street 1:409 TYLER HOLMES DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967
Mailing Address - Country:US
Mailing Address - Phone:662-283-4114
Mailing Address - Fax:662-283-3553
Practice Address - Street 1:700 WOODLAND DRIVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967
Practice Address - Country:US
Practice Address - Phone:662-283-3060
Practice Address - Fax:662-283-3553
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TYLER HOLMES MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1144840489OtherNPI
MS05586705Medicaid
MS1316557416OtherNPI
2466404OtherWELLCARE
MS000113703Medicaid
MS003558755Medicaid
MS1497164446OtherNPI
MS1700426707OtherNPI
MS09014346Medicaid
MS1881600492OtherNPI
MS200007660Medicaid
MS2087948OtherWELLCARE
MS2375774OtherWELLCARE
MS006456342Medicaid
MS1043662430OtherNPI
MS001608351Medicaid
MS003029302Medicaid
MS1285649855OtherNPI