Provider Demographics
NPI:1508831983
Name:DONALD C WHITE MD PA
Entity Type:Organization
Organization Name:DONALD C WHITE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-251-5600
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-6749
Mailing Address - Country:US
Mailing Address - Phone:620-251-5600
Mailing Address - Fax:620-251-2780
Practice Address - Street 1:1400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3306
Practice Address - Country:US
Practice Address - Phone:620-251-5600
Practice Address - Fax:620-252-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS150042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS340540OtherCHILDRENS MERCY HEALTH PL
OK100009890AOtherOKLA HEALTHCARE AUTHORITY
KS100084840AMedicaid
OK100009890AOtherOKLA HEALTHCARE AUTHORITY
KS100084840AMedicaid