Provider Demographics
NPI:1437389012
Name:NWMC WINFIELD PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:NWMC WINFIELD PHYSICIAN PRACTICES LLC
Other - Org Name:WILLIAM S KONETZKI MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:205-487-7736
Mailing Address - Street 1:200 CARRAWAY DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-5048
Mailing Address - Country:US
Mailing Address - Phone:205-487-0550
Mailing Address - Fax:205-487-0553
Practice Address - Street 1:200 CARRAWAY DR
Practice Address - Street 2:SUITE 2
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5048
Practice Address - Country:US
Practice Address - Phone:205-487-0550
Practice Address - Fax:205-487-0553
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NWMC WINFIELD PHYSICIAN PRACTICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28471208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510G700232Medicare PIN