Provider Demographics
NPI:1558836247
Name:WINNIE COMMUNITY HOSPITAL LLC
Entity Type:Organization
Organization Name:WINNIE COMMUNITY HOSPITAL LLC
Other - Org Name:RICELAND DIAGNOSTIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT MANAGER/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-614-2241
Mailing Address - Street 1:538 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WINNIE
Mailing Address - State:TX
Mailing Address - Zip Code:77665-7600
Mailing Address - Country:US
Mailing Address - Phone:409-296-6000
Mailing Address - Fax:409-296-6372
Practice Address - Street 1:3445 REGIONAL DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8063
Practice Address - Country:US
Practice Address - Phone:409-729-2299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINNIE COMMUNITY HOSPITAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-09
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX261QR0200XOtherTAXONOMY CODE