Healthcare Provider Details

I. General information

NPI: 1598292377
Provider Name (Legal Business Name): WHITE MOUNTAIN REGIONAL MEDICAL CENTER RURAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 N MAIN ST
EAGAR AZ
85925-9813
US

IV. Provider business mailing address

606 N MAIN ST
EAGAR AZ
85925-9813
US

V. Phone/Fax

Practice location:
  • Phone: 928-333-7173
  • Fax: 928-333-7157
Mailing address:
  • Phone: 928-333-7173
  • Fax: 928-333-7157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberH2530
License Number StateAZ

VIII. Authorized Official

Name: WESLEY BABERS
Title or Position: CEO
Credential:
Phone: 928-333-7178