Provider Demographics
NPI:1972845295
Name:NWMC-WINFIELD PHYSICIAN PRACTICES, LLC
Entity Type:Organization
Organization Name:NWMC-WINFIELD PHYSICIAN PRACTICES, LLC
Other - Org Name:NORTHWEST SPECIALTY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR-PHYSICIAN SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-565-1898
Mailing Address - Street 1:200 CARRAWAY DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-5048
Mailing Address - Country:US
Mailing Address - Phone:205-487-7000
Mailing Address - Fax:205-487-7666
Practice Address - Street 1:200 CARRAWAY DR
Practice Address - Street 2:SUITE 2
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5048
Practice Address - Country:US
Practice Address - Phone:205-487-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207RN0300X
208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty