Provider Demographics
NPI:1396788667
Name:THE WINSTON CLINIC, P.A.
Entity type:Organization
Organization Name:THE WINSTON CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-942-3000
Mailing Address - Street 1:506 LITTLE CREEK CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-7798
Mailing Address - Country:US
Mailing Address - Phone:870-942-3000
Mailing Address - Fax:870-942-3005
Practice Address - Street 1:506 LITTLE CREEK CUT OFF RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-7798
Practice Address - Country:US
Practice Address - Phone:870-942-3000
Practice Address - Fax:870-942-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127019002Medicaid