1386015097 NPI number — WHITE COUNTY MEDICAL CENTER

Table of content: (NPI 1386015097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386015097 NPI number — WHITE COUNTY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE COUNTY MEDICAL CENTER
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:
UNITY HEALTH BRADFORD MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
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:
1386015097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 W MAIN ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADFORD
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72020-9151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-344-8800
Provider Business Mailing Address Fax Number:
501-344-8805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 W MAIN ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72020-9151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-344-8800
Provider Business Practice Location Address Fax Number:
501-344-8805
Provider Enumeration Date:
10/08/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
STUART
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VP TREASURER
Authorized Official Telephone Number:
501-380-1004

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  AR4389 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 213300004 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".