Provider Demographics
NPI:1184911901
Name:WHITE COUNTY MEDICAL CENTER
Entity type:Organization
Organization Name:WHITE COUNTY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP- TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-380-1004
Mailing Address - Street 1:415 RODGERS DR STE A
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7434
Mailing Address - Country:US
Mailing Address - Phone:501-278-3297
Mailing Address - Fax:
Practice Address - Street 1:415 RODGERS DR STE A
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7434
Practice Address - Country:US
Practice Address - Phone:501-278-3297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-30
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR190991002Medicaid
AR5GA12Medicare PIN
AR040014Medicare Oscar/Certification
ARDS4755Medicare PIN