Provider Demographics
NPI:1457567281
Name:WINN-THRID PARTY INSURANCE
Entity Type:Organization
Organization Name:WINN-THRID PARTY INSURANCE
Other - Org Name:LLOYD C. HAWKS TMC-FT. STEWART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF, UBO
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-435-6175
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:STE 1D03
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-6037
Mailing Address - Fax:
Practice Address - Street 1:192 LINDQUIST ROAD
Practice Address - Street 2:BLDG 412
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-435-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINN-THRID PARTY INSURANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225081136OtherPARENT FACILITY WINN ACH NPI
OTH000Medicare UPIN
1225081136OtherPARENT FACILITY WINN ACH NPI