Provider Demographics
NPI:1780621326
Name:WINNSBORO MEDICAL CLINIC
Entity type:Organization
Organization Name:WINNSBORO MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-435-7333
Mailing Address - Street 1:3326 FRONT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-6487
Mailing Address - Country:US
Mailing Address - Phone:318-435-7333
Mailing Address - Fax:318-435-9061
Practice Address - Street 1:3326 FRONT ST
Practice Address - Street 2:SUITE B
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-6487
Practice Address - Country:US
Practice Address - Phone:318-435-7333
Practice Address - Fax:318-435-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA57790Medicare ID - Type Unspecified