Provider Demographics
NPI:1962415828
Name:WHITE OAK MEDICAL, INC
Entity type:Organization
Organization Name:WHITE OAK MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-294-2279
Mailing Address - Street 1:PO BOX 2032
Mailing Address - Street 2:
Mailing Address - City:BRANSON WEST
Mailing Address - State:MO
Mailing Address - Zip Code:65737-2032
Mailing Address - Country:US
Mailing Address - Phone:417-294-2279
Mailing Address - Fax:417-723-0228
Practice Address - Street 1:HC 81 BOX 8021
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-8102
Practice Address - Country:US
Practice Address - Phone:417-847-5800
Practice Address - Fax:417-847-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO263872261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO598857001Medicaid
MO263872Medicare Oscar/Certification
MOP98339Medicare UPIN
MOA10762Medicare UPIN