NPIMap

Organization Active NPI

Raymed PA

Doing business as White Hall Walk In Clinic

  • Clinic/Center
  • White Hall, AR
National Provider Identifier
1043692718
Registry record updated Jun 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
E7850 Issued in AR
Legal business name
RAYMED PA
Doing business as
White Hall Walk In Clinic
Practice address
7250 Sheridan Road
White Hall, AR 71602-0000
Phone
(501) 749-8892
NPI assigned
Jun 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Konstantin I Gubrij, M.D.
Title
President
Phone
(501) 410-3696

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X E7850 AR Primary

Addresses

Primary practice location

7250 Sheridan Road
White Hall, AR 71602-0000

Mailing address

PO Box 251753
Little Rock, AR 72225-1753
Phone (501) 410-3696

Other names 1

  • White Hall Walk In Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434585600000",
    "number": "1043692718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251753",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722251753",
            "telephone_number": "501-410-3696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7250 SHERIDAN ROAD",
            "city": "WHITE HALL",
            "state": "AR",
            "postal_code": "716020000",
            "telephone_number": "501-749-8892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAYMED PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-18",
        "last_updated": "2015-06-18",
        "status": "A",
        "authorized_official_last_name": "GUBRIJ",
        "authorized_official_first_name": "KONSTANTIN",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-410-3696",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AR",
            "license": "E7850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Hall Walk In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White Hall, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.