Provider Demographics
NPI:1780846493
Name:WINDSOR FAMILY MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:WINDSOR FAMILY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINDSOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-647-2111
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MO
Mailing Address - Zip Code:65360-0107
Mailing Address - Country:US
Mailing Address - Phone:660-647-2111
Mailing Address - Fax:660-647-2110
Practice Address - Street 1:114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360-1355
Practice Address - Country:US
Practice Address - Phone:660-647-2111
Practice Address - Fax:660-647-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO26D0721157261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0000328280OtherFAMILY HEALTH PARTNERS
MO1184625139OtherTYPE 1 NPI
MO240252908Medicaid
MOP00456003OtherRAIL ROAD MEDICARE
MO33420OtherHCUSA
MO7904OtherMERCY CARE PLUS
MO05245011OtherBLUE CROSS BLUE SHIELD
MO7904OtherMERCY CARE PLUS