Provider Demographics
NPI:1063660561
Name:CLINTON A. WINSLOW MD, INC
Entity Type:Organization
Organization Name:CLINTON A. WINSLOW MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-632-6681
Mailing Address - Street 1:1230 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1215
Mailing Address - Country:US
Mailing Address - Phone:405-810-9574
Mailing Address - Fax:405-632-6868
Practice Address - Street 1:4300 S SHIELDS BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-2864
Practice Address - Country:US
Practice Address - Phone:405-632-6681
Practice Address - Fax:405-632-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100253270BMedicaid
OK442447428PMedicare PIN
OKD42942Medicare UPIN