Healthcare Provider Details

I. General information

NPI: 1205596566
Provider Name (Legal Business Name): WHITE COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MCLAIN ST STE G
NEWPORT AR
72112-3550
US

IV. Provider business mailing address

1200 MCLAIN ST STE G
NEWPORT AR
72112-3550
US

V. Phone/Fax

Practice location:
  • Phone: 870-523-0193
  • Fax: 870-523-3583
Mailing address:
  • Phone: 870-523-0193
  • Fax: 870-523-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA GILLENWATER
Title or Position: CFO/VP TREASURER
Credential: CPA
Phone: 501-380-1010