Provider Demographics
NPI:1629311253
Name:WHITE COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:WHITE COUNTY MEDICAL CENTER
Other - Org Name:WESTSIDE FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, TREASURER
Authorized Official - Prefix:
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 1:103 WOODLANE DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6113
Mailing Address - Country:US
Mailing Address - Phone:501-268-3733
Mailing Address - Fax:501-207-6139
Practice Address - Street 1:103 WOODLANE DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6113
Practice Address - Country:US
Practice Address - Phone:501-268-3733
Practice Address - Fax:501-207-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199942002Medicaid
AR199942002Medicaid