Provider Demographics
NPI:1205006020
Name:WINSLOW INDIAN HEALTH CARE CENTER, INC.
Entity type:Organization
Organization Name:WINSLOW INDIAN HEALTH CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF DENTAL
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-289-6211
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:928-657-3824
Mailing Address - Fax:928-657-3828
Practice Address - Street 1:SWC NAVAJO ROUTE 15 & 60
Practice Address - Street 2:
Practice Address - City:DILKON
Practice Address - State:AZ
Practice Address - Zip Code:86047
Practice Address - Country:US
Practice Address - Phone:928-289-6116
Practice Address - Fax:928-289-6291
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:2023-07-06
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
AZ728719Medicaid