Basic Information
| Provider Information | |||||||||
| NPI: | 1225018146 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITE MOUNTAIN RADIOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 591 | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319020500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066531102 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2200 E SHOW LOW LAKE RD | ||||||||
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| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859017881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285376338 | ||||||||
| FaxNumber: | 9285325947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 01/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | PRINGLE | ||||||||
| AuthorizedOfficialFirstName: | EDGAR | ||||||||
| AuthorizedOfficialMiddleName: | JAY | ||||||||
| AuthorizedOfficialTitleorPosition: | NPI | ||||||||
| AuthorizedOfficialTelephone: | 9285376338 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.