Basic Information
| Provider Information | |||||||||
| NPI: | 1407327620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITE CLOUD HEALTH CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3349B THRASHER RD | ||||||||
| Address2: | |||||||||
| City: | WHITE CLOUD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660944005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855953450 | ||||||||
| FaxNumber: | 7855953493 | ||||||||
| Practice Location | |||||||||
| Address1: | 3349B THRASHER RD | ||||||||
| Address2: | |||||||||
| City: | WHITE CLOUD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660944005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855953450 | ||||||||
| FaxNumber: | 7855953493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2018 | ||||||||
| LastUpdateDate: | 12/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | DWAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7858501801 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.