Provider Demographics
NPI:1699766592
Name:WHITE MOUNTAIN REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:WHITE MOUNTAIN REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BABERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-333-7178
Mailing Address - Street 1:118 S MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGERVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85938-5104
Mailing Address - Country:US
Mailing Address - Phone:928-333-4368
Mailing Address - Fax:928-333-4369
Practice Address - Street 1:118 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGERVILLE
Practice Address - State:AZ
Practice Address - Zip Code:85938-5104
Practice Address - Country:US
Practice Address - Phone:928-333-4368
Practice Address - Fax:928-333-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH2530282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ192584Medicaid
AZ031315Medicare Oscar/Certification
AZ192584Medicaid