Healthcare Provider Details

I. General information

NPI: 1568928521
Provider Name (Legal Business Name): WINSLOW INDIAN HEALTH CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1.5 MILE N. LEUPP CHAPTER HOUSE
LEUPP AZ
86047
US

IV. Provider business mailing address

500 INDIANA AVE
WINSLOW AZ
86047-2169
US

V. Phone/Fax

Practice location:
  • Phone: 928-289-6565
  • Fax:
Mailing address:
  • Phone: 928-289-4646
  • Fax: 928-289-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. VIRGIL DAVIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 928-289-4646