Basic Information
| Provider Information | |||||||||
| NPI: | 1043390164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITENECK | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7001 ROGERS AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729034073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793144650 | ||||||||
| FaxNumber: | 4794521196 | ||||||||
| Practice Location | |||||||||
| Address1: | 7001 ROGERS AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729034073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793144650 | ||||||||
| FaxNumber: | 4794521196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/01/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 16062 | OK | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 2673528 | 01 | AR | MEDICARE | OTHER | 5I280 | 01 | AR | BLUE CROSS BLUE SHIELD | OTHER | 100100530A | 05 | OK | MEDICAID |