Provider Demographics
NPI:1659567329
Name:WINCHESTER MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WINCHESTER MEDICAL ASSOCIATES, LLC
Other - Org Name:NURSE PRACTITIONER GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-744-5111
Mailing Address - Street 1:475 SHOPPERS DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1380
Mailing Address - Country:US
Mailing Address - Phone:859-744-5111
Mailing Address - Fax:859-744-1177
Practice Address - Street 1:475 SHOPPERS DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1380
Practice Address - Country:US
Practice Address - Phone:859-744-5111
Practice Address - Fax:859-744-1177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINCHESTER MEDICAL ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-17
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78901261Medicaid