Provider Demographics
NPI:1528646585
Name:NEUROPATHY CENTER OF THE WHITE MOUNTAINS
Entity type:Organization
Organization Name:NEUROPATHY CENTER OF THE WHITE MOUNTAINS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODSIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-243-5970
Mailing Address - Street 1:932 MAIN ST
Mailing Address - Street 2:STE B203
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5585
Mailing Address - Country:US
Mailing Address - Phone:928-457-0961
Mailing Address - Fax:928-457-0929
Practice Address - Street 1:932 MAIN ST
Practice Address - Street 2:STE B203
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5585
Practice Address - Country:US
Practice Address - Phone:928-457-0961
Practice Address - Fax:928-457-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty