Provider Demographics
NPI:1659455806
Name:WHITE OAK MEDICAL, INC
Entity Type:Organization
Organization Name:WHITE OAK MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-272-0066
Mailing Address - Street 1:PO BOX 2032
Mailing Address - Street 2:
Mailing Address - City:BRANSON WEST
Mailing Address - State:MO
Mailing Address - Zip Code:65737-2032
Mailing Address - Country:US
Mailing Address - Phone:417-272-0066
Mailing Address - Fax:417-272-3224
Practice Address - Street 1:201 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CRANE
Practice Address - State:MO
Practice Address - Zip Code:65633
Practice Address - Country:US
Practice Address - Phone:417-272-0066
Practice Address - Fax:417-272-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00013475261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOI21750Medicare UPIN
MOA10762Medicare UPIN
MOP98339Medicare UPIN
MOS39181Medicare UPIN