| Organization Name: | WHITE MOUNTAIN SURGICAL SPECIALISTS PC |
| NPI Number: | 1164487922 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM J. WALDO (ADMINISTRATOR) |
| Mailing Address: | 2650 E Show Low Lake Rd Suite 2 Show Low |
| State: | AZ US |
| Postal Code: | 859017955 |
| Phone Number: | 9285374240 |
| Fax Number: | 9285374541 |
| NPI Enumeration Date: | 04/17/2006 |
| NPI Last Update Date: | 04/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | OSC0061 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |