Provider Demographics
NPI:1962696757
Name:JANA M WINBERG MDPA
Entity type:Organization
Organization Name:JANA M WINBERG MDPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-246-1014
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:KOUNTZE
Mailing Address - State:TX
Mailing Address - Zip Code:77625-0727
Mailing Address - Country:US
Mailing Address - Phone:409-246-1014
Mailing Address - Fax:406-246-1029
Practice Address - Street 1:345 S PINE ST
Practice Address - Street 2:
Practice Address - City:KOUNTZE
Practice Address - State:TX
Practice Address - Zip Code:77625-9329
Practice Address - Country:US
Practice Address - Phone:409-246-1014
Practice Address - Fax:409-246-1029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JANA M WINBERG MDPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-05
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1696619-03OtherMCD GROUP JEFF
1696619-03OtherMCD GROUP JEFF