Provider Demographics
NPI:1780815639
Name:SUSAN B WINCHESTER MD PC
Entity Type:Organization
Organization Name:SUSAN B WINCHESTER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-930-0806
Mailing Address - Street 1:800 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 640
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1620
Mailing Address - Country:US
Mailing Address - Phone:205-930-0806
Mailing Address - Fax:205-930-0906
Practice Address - Street 1:800 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 640
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1620
Practice Address - Country:US
Practice Address - Phone:205-930-0806
Practice Address - Fax:205-930-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000024976Medicaid
AL000024976Medicaid