Provider Demographics
NPI:1609019157
Name:NWMC-WINFIELD PHYSICIAN PRACTICES, LLC
Entity Type:Organization
Organization Name:NWMC-WINFIELD PHYSICIAN PRACTICES, LLC
Other - Org Name:NORTHWEST EMERGENCY PHYSICIANS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATIONAL DIVISION PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BIVACCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-1602
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-0809
Mailing Address - Country:US
Mailing Address - Phone:205-487-7000
Mailing Address - Fax:205-487-7666
Practice Address - Street 1:1530 US HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5056
Practice Address - Country:US
Practice Address - Phone:205-487-7000
Practice Address - Fax:205-487-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ190Medicare PIN