MEDICARE: WHITE COUNTY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295285906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE COUNTY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 429
Second Line	:
City	:	CLINTON
State	:	AR
Zip	:	72031-0429
Country	:	US
Telephone Number	:	501-745-3033
Fax Number	:	501-745-8099

Provider Business Practice Location Address
First Line	:	175 VOLUNTEER PKWY
Second Line	:
City	:	CLINTON
State	:	AR
Zip	:	72031-8001
Country	:	US
Telephone Number	:	501-745-3033
Fax Number	:	501-745-8099

Authorized Official
Title or Position	:	CFO/VP TREASURER
Name	:	LAURA GILLENWATER
Credential	:	CPA
Telephone Number	:	501-380-1010

Provider Enumeration Date	:	10/05/2016
Last Update Date	:	09/18/2025

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Directions to “WHITE COUNTY MEDICAL CENTER ” Practice Location

Language	Start Address	Practice Location

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