Provider Demographics
NPI:1467600379
Name:WINECOFF FAMILY PRACTICE
Entity Type:Organization
Organization Name:WINECOFF FAMILY PRACTICE
Other - Org Name:WINECOFF FAMILY PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-262-7901
Mailing Address - Street 1:304 WINECOFF SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4172
Mailing Address - Country:US
Mailing Address - Phone:704-262-7901
Mailing Address - Fax:704-262-7902
Practice Address - Street 1:304 WINECOFF SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4172
Practice Address - Country:US
Practice Address - Phone:704-262-7901
Practice Address - Fax:704-262-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950529Medicaid
NC2319872Medicare PIN