Winston Medical Clinic Fair Elementary School

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R860217 Issued in MS

Legal business name

WINSTON MEDICAL CLINIC FAIR ELEMENTARY SCHOOL

Doing business as

Winston Medical Clinic LLC

Practice address

301 N Columbus Ave
Louisville, MS 39339-2315

Phone

(662) 446-1972

Fax

(662) 446-1039

NPI assigned

Jan 12, 2016

Last updated

Jan 12, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

WINSTON MEDICAL CLINIC LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debra J Fryery

Title

Director of Clinic Operations

Phone

(662) 446-1972

Specialties & licenses 1

Addresses

Other names 1

• Winston Medical Clinic LLC Doing business as

Tax ID family

Winston Medical Clinic Fair Elementary School3 organizations share this tax ID, including this one

Part of

Winston Medical Clinic Fair Elementary School

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Winston Medical Clinic LLC

  dba Winston Medical Clinic Noxapater

  • Rural Health Clinic/Center
  • Noxapater, MS
  • NPI 1588091714
  NPD tax ID
• Winston Medical Clinic LLC

  • Rural Health Clinic/Center
  • Louisville, MS
  • NPI 1629417324
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Winston Medical Clinic LLC

  • Rural Health Clinic/Center
  • Louisville, MS
  • NPI 1629417324
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452556800000",
    "number": "1023474780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 470",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393390470",
            "telephone_number": "662-446-1972",
            "fax_number": "552-446-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N COLUMBUS AVE",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393392315",
            "telephone_number": "662-446-1972",
            "fax_number": "662-446-1039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINSTON MEDICAL CLINIC FAIR ELEMENTARY SCHOOL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WINSTON MEDICAL CLINIC LLC",
        "enumeration_date": "2016-01-12",
        "last_updated": "2016-01-12",
        "status": "A",
        "authorized_official_last_name": "FRYERY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR OF CLINIC OPERATIONS",
        "authorized_official_telephone_number": "662-446-1972"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R860217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Winston Medical Clinic LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Winston County Medical Foundation (Winston Medical Center)
• Winston County Medical Foundation (Winston Medical Center)
• Winston County Medical Foundation (Winston Medical Center)
• Winston County Medical Foundation (Winston Medical Center)
• Winston County Medical Foundation (Winston Medical Center)
• Winston Medical Clinic LLC (Winston Medical Clinic Main Street)
• Winston Medical Clinic LLC
• WMC Emergency Services LLC
• Sarah Woodward
• Richard L Wright, RPH

• Family Nurse Practitioner in Louisville, MS
• Providers in Louisville, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.