Provider Demographics
NPI:1194551168
Name:WHITEVILLE MEDICAL CENTER LLC
Entity type:Organization
Organization Name:WHITEVILLE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-483-5370
Mailing Address - Street 1:2400 US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38075-7461
Mailing Address - Country:US
Mailing Address - Phone:731-254-8999
Mailing Address - Fax:731-254-8997
Practice Address - Street 1:2400 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38075-7461
Practice Address - Country:US
Practice Address - Phone:731-254-8999
Practice Address - Fax:731-254-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty