Provider Demographics
NPI:1538321674
Name:WINSLOW MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:WINSLOW MEMORIAL HOSPITAL INC
Other - Org Name:LITTLE COLORADO PHYSICIANS OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-289-4691
Mailing Address - Street 1:1501 N 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 1:200 E LEE ST
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:928-289-3396
Practice Address - Fax:928-289-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X, 208000000X, 208600000X, 208D00000X
AZ03-8507261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ976516Medicaid
AZ256316Medicaid
AZ708894Medicaid
AZ176132Medicaid
AZ117995Medicare PIN
AZ976516Medicaid