Basic Information
| Provider Information | |||||||||
| NPI: | 1063164820 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITE COUNTY MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | NEWPORT ER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3214 E RACE AVE | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721434810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013803172 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1205 MCLAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721123533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013803172 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2022 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | HILL | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
| AuthorizedOfficialMiddleName: | RANDALL | ||||||||
| AuthorizedOfficialTitleorPosition: | VP TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 5013801004 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WHITE COUNTY MEDICAL CENTER | ||||||||
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| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.