Provider Demographics
NPI:1467580894
Name:WHITE MOUNTAIN FAMILY PRACTICE ASSOCIATES LTD
Entity Type:Organization
Organization Name:WHITE MOUNTAIN FAMILY PRACTICE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-532-5838
Mailing Address - Street 1:5658 HIGHWAY 260
Mailing Address - Street 2:SUITE 19
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5189
Mailing Address - Country:US
Mailing Address - Phone:928-532-5838
Mailing Address - Fax:928-532-6670
Practice Address - Street 1:5658 HIGHWAY 260
Practice Address - Street 2:SUITE 19
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5189
Practice Address - Country:US
Practice Address - Phone:928-532-5838
Practice Address - Fax:928-532-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCGRPMedicare PIN