Provider Demographics
NPI:1992837330
Name:LLOYD P VAN WINKLE, MD, PA
Entity Type:Organization
Organization Name:LLOYD P VAN WINKLE, MD, PA
Other - Org Name:MEDINA VALLEY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/S CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:P
Authorized Official - Last Name:VAN WINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-538-2254
Mailing Address - Street 1:409 MADRID ST
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-4527
Mailing Address - Country:US
Mailing Address - Phone:830-538-2254
Mailing Address - Fax:830-931-2259
Practice Address - Street 1:409 MADRID ST
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-4527
Practice Address - Country:US
Practice Address - Phone:830-538-2254
Practice Address - Fax:830-931-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2015-08-07
Deactivation Date:2008-07-15
Deactivation Code:
Reactivation Date:2008-10-07
Provider Licenses
StateLicense IDTaxonomies
TXG3878261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D0498955OtherCLIA
TX142464002Medicaid
TX142464001Medicaid
TXTXB104619OtherMEDICARE ID TYPE UNSPECIFIED
TXR14737OtherRADIATION CONTROL ID
TXR14737OtherRADIATION CONTROL ID