Provider Demographics
NPI:1912008806
Name:WINBUSH, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WINBUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0357
Mailing Address - Country:US
Mailing Address - Phone:864-225-7401
Mailing Address - Fax:864-225-7201
Practice Address - Street 1:803 N FANT ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5700
Practice Address - Country:US
Practice Address - Phone:864-225-7401
Practice Address - Fax:864-225-7201
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09409208VP0014X
NY221849207R00000X
NY207641207LH0002X
SC36606207R00000X
NY2012522207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC366062Medicaid