Basic Information
Provider Information | |||||||||
NPI: | 1083665061 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WINKLER | ||||||||
FirstName: | CHARLES | ||||||||
MiddleName: | F | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 7564 | ||||||||
Address2: |   | ||||||||
City: | PADUCAH | ||||||||
State: | KY | ||||||||
PostalCode: | 420027564 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2705540011 | ||||||||
FaxNumber: | 2705546540 | ||||||||
Practice Location | |||||||||
Address1: | 100 KIANA CT | ||||||||
Address2: |   | ||||||||
City: | PADUCAH | ||||||||
State: | KY | ||||||||
PostalCode: | 420016787 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2705540011 | ||||||||
FaxNumber: | 2705546540 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/13/2006 | ||||||||
LastUpdateDate: | 01/13/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MD0000020188 | TN | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 17391 | KY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 000000329300 | 01 | KY | ANTHEM BCBS OF KY | OTHER | 0910601 | 01 | KY | UMWA | OTHER | C70713 | 01 | KY | BLUEGRASS FAMILY HEALTH | OTHER | 069193 | 01 | KY | HEALTH ALLIANCE | OTHER | 4079538 | 01 | TN | BCBS OF TN | OTHER | 64173917 | 05 | KY |   | MEDICAID | 3048083 | 05 | TN |   | MEDICAID | 5007956 | 01 | TN | TLC-FAMILYCAREHLTHPLAN | OTHER | 000000236012 | 01 | TN | UNISON HEALTH MEDICARE ADVANTAGE | OTHER | 020248399 | 01 |   | DEPT OF LABOR | OTHER | 179570 | 01 | KY | HEALTH LINK | OTHER | 2968 | 01 | KY | CHA HEALTH | OTHER |