Provider Demographics
NPI:1437575545
Name:WHITE CRANES MEDICAL CENTER INCORPORATED
Entity Type:Organization
Organization Name:WHITE CRANES MEDICAL CENTER INCORPORATED
Other - Org Name:WHITE CRANES MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JELINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:IP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-704-4540
Mailing Address - Street 1:2050 S COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3014
Mailing Address - Country:US
Mailing Address - Phone:480-704-4540
Mailing Address - Fax:
Practice Address - Street 1:2050 S COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3014
Practice Address - Country:US
Practice Address - Phone:480-704-4540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03-745175F00000X
AZ0995207K00000X, 207Q00000X, 208VP0000X
208000000X, 208100000X, 2083P0500X
AZ208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty