Provider Demographics
NPI:1780720722
Name:W H WHITESIDE INC
Entity type:Organization
Organization Name:W H WHITESIDE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:WHITESIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-681-0086
Mailing Address - Street 1:5002 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4166
Mailing Address - Country:US
Mailing Address - Phone:316-681-0086
Mailing Address - Fax:316-681-8013
Practice Address - Street 1:5002 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4166
Practice Address - Country:US
Practice Address - Phone:316-681-0086
Practice Address - Fax:316-681-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
103005OtherBCBS
663070OtherFIRST GUARD