Provider Demographics
NPI:1124177571
Name:WHITE MOUNTAIN SURGICAL SPECIALISTS PC
Entity type:Organization
Organization Name:WHITE MOUNTAIN SURGICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-537-4240
Mailing Address - Street 1:2650 E SHOW LOW LAKE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7955
Mailing Address - Country:US
Mailing Address - Phone:928-537-4240
Mailing Address - Fax:
Practice Address - Street 1:2650 E SHOW LOW LAKE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7955
Practice Address - Country:US
Practice Address - Phone:928-537-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE MTN SURGICAL SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ13617207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0180910OtherBCBS AZ
AZ16090179OtherST COMP FUND AZ
AZ214502Medicaid
AZ214502001Medicaid
AZ214502Medicaid
AZZWCHYQMedicare PIN