Provider Demographics
NPI:1346233640
Name:BERNARD WILLIAM SIMIERITSCH
Entity Type:Organization
Organization Name:BERNARD WILLIAM SIMIERITSCH
Other - Org Name:WINSTON COUNTY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SIMIERITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-489-3322
Mailing Address - Street 1:15341 HIGHWAY 278
Mailing Address - Street 2:
Mailing Address - City:DOUBLE SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:35553-2407
Mailing Address - Country:US
Mailing Address - Phone:205-489-3322
Mailing Address - Fax:205-489-3325
Practice Address - Street 1:15341 HIGHWAY 278
Practice Address - Street 2:
Practice Address - City:DOUBLE SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:35553-2407
Practice Address - Country:US
Practice Address - Phone:205-489-3322
Practice Address - Fax:205-489-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ051550393Medicaid
AL541003924Medicaid
AL013924Medicare Oscar/Certification
ALG11448Medicare UPIN
ALP24329Medicare UPIN