Healthcare Provider Details

I. General information

NPI: 1518286418
Provider Name (Legal Business Name): WINSLOW MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 BURKE RD
PASADENA TX
77504-3451
US

IV. Provider business mailing address

4002 BURKE RD
PASADENA TX
77504-3451
US

V. Phone/Fax

Practice location:
  • Phone: 281-606-2020
  • Fax: 280-606-2021
Mailing address:
  • Phone: 281-606-2020
  • Fax: 280-606-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD4453
License Number StateTX

VIII. Authorized Official

Name: DR. RAY EUGENE WARREN
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 281-360-7502