Provider Demographics
NPI:1528094281
Name:WINCHESTER FAMILY PRACTICE, PSC
Entity type:Organization
Organization Name:WINCHESTER FAMILY PRACTICE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-744-1445
Mailing Address - Street 1:1110 MCCANN DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391
Mailing Address - Country:US
Mailing Address - Phone:859-744-1445
Mailing Address - Fax:859-744-1442
Practice Address - Street 1:1110 MCCANN DR
Practice Address - Street 2:SUITE B
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1157
Practice Address - Country:US
Practice Address - Phone:859-744-1445
Practice Address - Fax:859-744-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001445Medicaid
KYH52234Medicare UPIN
KY183903Medicare Oscar/Certification
KY7241Medicare PIN