Healthcare Provider Details

I. General information

NPI: 1609148832
Provider Name (Legal Business Name): HOSPITAL INPATIENT SERVICES OF WINSLOW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 12/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N WILLIAMSON AVE
WINSLOW AZ
86047-2735
US

IV. Provider business mailing address

13737 NOEL RD STE 1600
DALLAS TX
75240-1331
US

V. Phone/Fax

Practice location:
  • Phone: 928-289-4691
  • Fax:
Mailing address:
  • Phone: 469-401-2386
  • Fax: 214-712-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD GODBOLD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 469-401-2386