Provider Demographics
NPI:1366701708
Name:WHITE MOUNTAIN HEALTH LLC
Entity type:Organization
Organization Name:WHITE MOUNTAIN HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLLANDER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:808-887-1210
Mailing Address - Street 1:PO BOX 25490
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-0490
Mailing Address - Country:US
Mailing Address - Phone:808-536-0300
Mailing Address - Fax:808-536-0320
Practice Address - Street 1:65-1235A OPELO ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8401
Practice Address - Country:US
Practice Address - Phone:808-887-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty