Provider Demographics
NPI:1194288480
Name:WHITE CLOUD HEALTH CENTER, LLC
Entity type:Organization
Organization Name:WHITE CLOUD HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-557-8320
Mailing Address - Street 1:3349B THRASHER RD
Mailing Address - Street 2:
Mailing Address - City:WHITE CLOUD
Mailing Address - State:KS
Mailing Address - Zip Code:66094-4005
Mailing Address - Country:US
Mailing Address - Phone:785-595-3450
Mailing Address - Fax:
Practice Address - Street 1:3349B THRASHER RD
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:KS
Practice Address - Zip Code:66094-4005
Practice Address - Country:US
Practice Address - Phone:785-595-3450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy