Healthcare Provider Details

I. General information

NPI: 1346313145
Provider Name (Legal Business Name): WHITE OAK MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N MAIN
CRANE MO
65633
US

IV. Provider business mailing address

PO BOX 2032
BRANSON WEST MO
65737-2032
US

V. Phone/Fax

Practice location:
  • Phone: 417-723-1047
  • Fax: 417-723-0228
Mailing address:
  • Phone: 417-272-0066
  • Fax: 417-272-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number263924
License Number StateMO

VIII. Authorized Official

Name: DAISY R MCBEE
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 417-272-0066