Provider Demographics
NPI:1457056566
Name:WYNN MEDICAL CENTER
Entity Type:Organization
Organization Name:WYNN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:276-231-9228
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:DUFFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24244-0408
Mailing Address - Country:US
Mailing Address - Phone:276-231-9227
Mailing Address - Fax:949-695-2477
Practice Address - Street 1:225 BOONE TRAIL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244
Practice Address - Country:US
Practice Address - Phone:276-231-9228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service