Provider Demographics
NPI:1407015134
Name:WINSLOW COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WINSLOW COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VINNEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-789-2529
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:IN
Mailing Address - Zip Code:47598-0516
Mailing Address - Country:US
Mailing Address - Phone:812-789-2529
Mailing Address - Fax:812-789-2574
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:IN
Practice Address - Zip Code:47598-5423
Practice Address - Country:US
Practice Address - Phone:812-789-2529
Practice Address - Fax:812-789-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28143885A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherTAX ID
IN257000Medicare PIN