1346313145 NPI number — WHITE OAK MEDICAL, INC

Table of content: (NPI 1346313145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346313145 NPI number — WHITE OAK MEDICAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE OAK MEDICAL, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346313145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2032
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANSON WEST
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65737-2032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-272-0066
Provider Business Mailing Address Fax Number:
417-272-3224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-723-1047
Provider Business Practice Location Address Fax Number:
417-723-0228
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCBEE
Authorized Official First Name:
DAISY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
417-272-0066

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  263924 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)