Provider Demographics
NPI:1992715254
Name:WINCHESTER INTERNAL MEDICINE, PSC
Entity type:Organization
Organization Name:WINCHESTER INTERNAL MEDICINE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUENTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-745-4833
Mailing Address - Street 1:131 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2621
Mailing Address - Country:US
Mailing Address - Phone:859-737-5126
Mailing Address - Fax:859-737-5127
Practice Address - Street 1:1414 W LEXINGTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1184
Practice Address - Country:US
Practice Address - Phone:859-745-4833
Practice Address - Fax:859-745-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYI35280Medicare UPIN