NPIMap

Organization Active NPI

Winslow Memorial Hospital Inc

Doing business as Little Colorado Physicians Office

  • Rural Health Clinic/Center
  • Winslow, AZ
National Provider Identifier
1144710203
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
03-8507 Issued in AZ
Legal business name
WINSLOW MEMORIAL HOSPITAL INC
Doing business as
Little Colorado Physicians Office
Practice address
200 Lee St
Winslow, AZ 86047-2603
Phone
(928) 289-3396
Fax
(928) 289-2801
NPI assigned
May 15, 2018
Last updated
Feb 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Travis Udall
Title
Ceo
Phone
(928) 289-4691

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 03-8507 AZ Primary

Addresses

Primary practice location

200 Lee St
Winslow, AZ 86047-2603

Mailing address

1501 N Williamson Ave
Winslow, AZ 86047-2735
Phone (928) 289-4691

Other names 1

  • Little Colorado Physicians Office Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170524001348 AZ Part A Provider - Rural Health Clinic 8628988409 1 other NPI on this enrollment
Practice locations: Winslow, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144710203. Details of each certification follow.

Rural health clinic certification: CCN 038507

Legal name
WINSLOW MEMORIAL HOSPITAL INC
Doing business as
LITTLE COLORADO PHYSICIANS OFFICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 29, 2017
Last certification
Jul 21, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 10, 1951 in AZ
Enrollment address
200 Lee St
Winslow, AZ 86047-2603
Related CCNs
031311

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Winslow Memorial Phys H2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rhonda Greer Individual Corporate DirectorBoard Member Apr 1, 1997
Lona M King Individual Corporate DirectorChief Financial Officer Nov 1, 2022
Thomas E Greenwood Individual W-2 Managing EmployeeChief of Staff Jan 1, 2001
Jay Despain Individual Corporate DirectorBoard Member Apr 1, 2016
David Coolidge Individual Corporate DirectorBoardmember Director Apr 1, 2013
John J. Dempsey Individual Corporate OfficerCeo Mar 11, 2015
Loren Sadler Individual Corporate Director Apr 1, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1144710203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 N WILLIAMSON AVE",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860472735",
            "telephone_number": "928-289-4691",
            "fax_number": "928-289-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 LEE ST",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860472603",
            "telephone_number": "928-289-3396",
            "fax_number": "928-289-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINSLOW MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-15",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "UDALL",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-289-4691"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": "03-8507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little Colorado Physicians Office",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Little Colorado Physicians Office",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winslow, AZ

Sources for this page

Verify at the official NPI Registry.