1497925218 NPI number — WINSLOW INDIAN HEALTH CARE CENTER, INC

Table of content: (NPI 1497925218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497925218 NPI number — WINSLOW INDIAN HEALTH CARE CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINSLOW INDIAN HEALTH CARE CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497925218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSLOW
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86047-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-686-6554
Provider Business Mailing Address Fax Number:
928-626-6566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1.5 MILE N OF LEUPP CHAPTER HOUSE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEUPP
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-686-6554
Provider Business Practice Location Address Fax Number:
928-686-6566
Provider Enumeration Date:
03/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OF DENTAL
Authorized Official Telephone Number:
928-289-4646

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 758526 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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