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General NPI Number Information
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NPI Number | 1497277651
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Entity Type | Organization
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Legal Business Name | WHITE MOUNTAIN REGIONAL MEDICAL CENTER RURAL HEALTH CLINIC - ST. JOHNS
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 110 EAST FIRST STREET SOUTH
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City | ST. JOHNS
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State | AZ
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Zip | 85936
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Country | US
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Telephone | 928-333-7333
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Fax | 928-333-7157
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Provider Business Mailing Address
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Address Line | 118 S MOUNTAIN AVE
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City | SPRINGERVILLE
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State | AZ
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Zip | 85938-5104
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Country | US
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Telephone | 928-333-7333
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Fax | 928-333-7157
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | TRACY NELSON
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Credential | RN-BC
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Telephone | 928-333-7173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OTC7868
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License Number State | AZ
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