Provider Demographics
NPI:1386015097
Name:WHITE COUNTY MEDICAL CENTER
Entity type:Organization
Organization Name:WHITE COUNTY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-380-1004
Mailing Address - Street 1:504 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:AR
Mailing Address - Zip Code:72020-9151
Mailing Address - Country:US
Mailing Address - Phone:501-344-8800
Mailing Address - Fax:501-344-8805
Practice Address - Street 1:504 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:AR
Practice Address - Zip Code:72020-9151
Practice Address - Country:US
Practice Address - Phone:501-344-8800
Practice Address - Fax:501-344-8805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-08
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4389261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR213300004Medicaid