Healthcare Provider Details

I. General information

NPI: 1477653889
Provider Name (Legal Business Name): WINSLOW MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WILLIAMSON AVE
WINSLOW AZ
86047-2735
US

IV. Provider business mailing address

1501 WILLIAMSON AVE
WINSLOW AZ
86047-2735
US

V. Phone/Fax

Practice location:
  • Phone: 928-289-4691
  • Fax: 928-289-3855
Mailing address:
  • Phone: 928-289-4691
  • Fax: 928-289-3855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number03-8507
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberRGH0076
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. TRAVIS UDALL
Title or Position: CEO
Credential:
Phone: 928-289-4691