Provider Demographics
NPI:1568652709
Name:WINSLOW MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WINSLOW MEDICAL CENTER, INC.
Other - Org Name:KINGWOOD URGENT CARE AND SPECIAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:PETRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-360-7502
Mailing Address - Street 1:2601 W LAKE HOUSTON PKWY
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5222
Mailing Address - Country:US
Mailing Address - Phone:281-360-7502
Mailing Address - Fax:
Practice Address - Street 1:2601 W LAKE HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5222
Practice Address - Country:US
Practice Address - Phone:281-360-7502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3356302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization