Provider Demographics
NPI:1699828657
Name:CHRISTOPHER L WINSLOW MD PA
Entity Type:Organization
Organization Name:CHRISTOPHER L WINSLOW MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-508-2644
Mailing Address - Street 1:400 S COLLEGE ST
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3923
Mailing Address - Country:US
Mailing Address - Phone:870-508-2646
Mailing Address - Fax:870-508-2644
Practice Address - Street 1:400 S COLLEGE ST
Practice Address - Street 2:SUITE # 2
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3923
Practice Address - Country:US
Practice Address - Phone:870-508-2646
Practice Address - Fax:870-508-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE 4224261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155109001Medicaid
AR155109001Medicaid
AR5N028Medicare ID - Type Unspecified