Provider Demographics
NPI:1497925218
Name:WINSLOW INDIAN HEALTH CARE CENTER, INC
Entity Type:Organization
Organization Name:WINSLOW INDIAN HEALTH CARE CENTER, INC
Other - Org Name:LEUPP DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF DENTAL
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-289-4646
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-0400
Mailing Address - Country:US
Mailing Address - Phone:928-686-6554
Mailing Address - Fax:928-626-6566
Practice Address - Street 1:1.5 MILE N OF LEUPP CHAPTER HOUSE
Practice Address - Street 2:
Practice Address - City:LEUPP
Practice Address - State:AZ
Practice Address - Zip Code:86032
Practice Address - Country:US
Practice Address - Phone:928-686-6554
Practice Address - Fax:928-686-6566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINSLOW INDIAN HEALTH CARE CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-07
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ758526Medicaid