Provider Demographics
NPI:1316180664
Name:EUFAULA MEDICINE PLLC
Entity Type:Organization
Organization Name:EUFAULA MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-781-9466
Mailing Address - Street 1:211 S 36TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5044
Mailing Address - Country:US
Mailing Address - Phone:918-781-9466
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-4010
Practice Address - Country:US
Practice Address - Phone:918-689-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty