Provider Demographics
NPI:1477653889
Name:WINSLOW MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:WINSLOW MEMORIAL HOSPITAL INC
Other - Org Name:LITTLE COLORADO MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:UDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-289-4691
Mailing Address - Street 1:1501 WILLIAMSON AVE
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-2735
Mailing Address - Country:US
Mailing Address - Phone:928-289-4691
Mailing Address - Fax:928-289-3855
Practice Address - Street 1:1501 WILLIAMSON AVE
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-2735
Practice Address - Country:US
Practice Address - Phone:928-289-4691
Practice Address - Fax:928-289-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03-8507261QR1300X
AZRGH0076282NC0060X
AZ282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ176132Medicaid
AZ020389Medicaid
AZ020389Medicaid
AZ031311Medicare Oscar/Certification
AZ176132Medicaid