1285806703 NPI number — WHITE OAK MEDICAL, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285806703 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:
1285806703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2009
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:
417-294-2279
Provider Business Mailing Address Fax Number:
417-723-0228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11016 STATE HIGHWAY 76
Provider Second Line Business Practice Location Address:
CLAYBOUGH PLAZA, STE 6
Provider Business Practice Location Address City Name:
BRANSON WEST
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65737-9775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-272-0505
Provider Business Practice Location Address Fax Number:
417-272-3020
Provider Enumeration Date:
03/25/2008

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:
417-294-2279

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 596068007 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com