Provider Demographics
NPI:1588865570
Name:WINSTON COUNTY MEDICAL CLINIC 2
Entity type:Organization
Organization Name:WINSTON COUNTY MEDICAL CLINIC 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMIERITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-489-3322
Mailing Address - Street 1:15341 HIGHWAY 278
Mailing Address - Street 2:
Mailing Address - City:DOUBLE SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:35553-2407
Mailing Address - Country:US
Mailing Address - Phone:205-489-3322
Mailing Address - Fax:205-789-3325
Practice Address - Street 1:15341 HIGHWAY 278
Practice Address - Street 2:
Practice Address - City:DOUBLE SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:35553-2407
Practice Address - Country:US
Practice Address - Phone:205-489-3322
Practice Address - Fax:205-789-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18982261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51530751OtherBLUE CROSS
AL541392401Medicaid
AL529601630Medicaid
AL000036224Medicaid
AL051550393Medicaid
AL51036224OtherBLUE CROSS
AL000036224Medicaid
AL529601630Medicaid
AL013924Medicare Oscar/Certification