Provider Demographics
NPI:1144710203
Name:WINSLOW MEMORIAL HOSPITAL INC
Entity type:Organization
Organization Name:WINSLOW MEMORIAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:UDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-289-4691
Mailing Address - Street 1:1501 N WILLIAMSON AVE
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-2735
Mailing Address - Country:US
Mailing Address - Phone:928-289-4691
Mailing Address - Fax:928-289-0049
Practice Address - Street 1:200 LEE ST
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-2603
Practice Address - Country:US
Practice Address - Phone:928-289-3396
Practice Address - Fax:928-289-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03-8507261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health