Provider Demographics
NPI:1083778302
Name:WHITE COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:WHITE COUNTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-380-1004
Mailing Address - Street 1:3214 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4810
Mailing Address - Country:US
Mailing Address - Phone:501-268-6121
Mailing Address - Fax:501-380-1011
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7321
Practice Address - Country:US
Practice Address - Phone:501-278-3100
Practice Address - Fax:501-380-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4331273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR010014OtherARK BC BS PROVIDER NUMBER
AR129186105Medicaid
04S014Medicare Oscar/Certification