Provider Demographics
NPI:1154717536
Name:WINNSBORO HEALTH SERVICES PLLC
Entity type:Organization
Organization Name:WINNSBORO HEALTH SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, AUTHORIZED MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-342-3355
Mailing Address - Street 1:209 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-2604
Mailing Address - Country:US
Mailing Address - Phone:903-342-3355
Mailing Address - Fax:903-342-3350
Practice Address - Street 1:209 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-2604
Practice Address - Country:US
Practice Address - Phone:903-342-3355
Practice Address - Fax:903-342-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-12
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty