Provider Demographics
NPI:1417221227
Name:WINCHESTER INTEGRATIVE HEALTH & WELLNESS, PLLC
Entity Type:Organization
Organization Name:WINCHESTER INTEGRATIVE HEALTH & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-450-0319
Mailing Address - Street 1:423 W CORK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3812
Mailing Address - Country:US
Mailing Address - Phone:540-450-0319
Mailing Address - Fax:
Practice Address - Street 1:423 W CORK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3812
Practice Address - Country:US
Practice Address - Phone:540-450-0319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236241208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010088542Medicaid
VA010088542Medicaid