=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205596566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITE COUNTY MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2021
-----------------------------------------------------
Last Update Date | 09/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 MCLAIN ST STE G
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72112-3550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-523-0193
-----------------------------------------------------
Fax | 870-523-3583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 MCLAIN ST STE G
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72112-3550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-523-0193
-----------------------------------------------------
Fax | 870-523-3583
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO/VP TREASURER
-----------------------------------------------------
Name | LAURA GILLENWATER
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 501-380-1010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------