Provider Demographics
NPI:1952417776
Name:WINSTON TECHNOLOGY INC
Entity Type:Organization
Organization Name:WINSTON TECHNOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOYDE
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-486-5234
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-0655
Mailing Address - Country:US
Mailing Address - Phone:205-486-5234
Mailing Address - Fax:205-486-5232
Practice Address - Street 1:525 LAYNE HILL DRIVE
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565
Practice Address - Country:US
Practice Address - Phone:205-486-5234
Practice Address - Fax:205-486-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH742Medicare ID - Type UnspecifiedPAYER NUMBER