Provider Demographics
NPI:1184606865
Name:WINCHESTER PHYSICIAN ASSOCIATES, INC
Entity type:Organization
Organization Name:WINCHESTER PHYSICIAN ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-756-7273
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-4260
Mailing Address - Country:US
Mailing Address - Phone:781-756-7273
Mailing Address - Fax:781-721-0725
Practice Address - Street 1:11 SHORE RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2855
Practice Address - Country:US
Practice Address - Phone:781-729-1810
Practice Address - Fax:781-729-4577
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINCHESTER PHYSICIAN ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-17
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156047207Q00000X
MA70291207R00000X
MA203423207R00000X
MA77272207R00000X
MA73703207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9777229Medicaid
MAM20224Medicare PIN
MA9777229Medicaid