Provider Demographics
NPI:1699859967
Name:NWMC-WINFIELD PHYSICIAN PRACTICES, LLC
Entity Type:Organization
Organization Name:NWMC-WINFIELD PHYSICIAN PRACTICES, LLC
Other - Org Name:DETROIT MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TSIMPIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-979-8861
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:AL
Mailing Address - Zip Code:35552-0140
Mailing Address - Country:US
Mailing Address - Phone:205-468-3355
Mailing Address - Fax:205-468-3382
Practice Address - Street 1:65434 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:AL
Practice Address - Zip Code:35552
Practice Address - Country:US
Practice Address - Phone:205-468-3355
Practice Address - Fax:205-468-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ187Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER