Provider Demographics
NPI:1427044627
Name:BELL-WINSTONCLINIC,P.A.
Entity Type:Organization
Organization Name:BELL-WINSTONCLINIC,P.A.
Other - Org Name:ELAINE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:870-827-3250
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:ELAINE
Mailing Address - State:AR
Mailing Address - Zip Code:72333-0717
Mailing Address - Country:US
Mailing Address - Phone:870-827-3250
Mailing Address - Fax:870-827-3296
Practice Address - Street 1:112 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELAINE
Practice Address - State:AR
Practice Address - Zip Code:72333
Practice Address - Country:US
Practice Address - Phone:870-827-3250
Practice Address - Fax:870-827-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128762729Medicaid
AR5B916Medicare PIN
AR128762729Medicaid