White Tank Medical PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WHITE TANK MEDICAL PLLC

Practice address

18761 N Reems Rd Ste 400
Surprise, AZ 85374-8646

Phone

(623) 583-9180

NPI assigned

Mar 23, 2023

Last updated

Mar 23, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Justin James Woodside

Title

Owner

Phone

(623) 583-9180

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

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.

• Jacob Hamblin Healey, D.C.

  • Chiropractor
  • Goodyear, AZ
  • NPI 1578844874
  Medicare reassignment Care Compare group NPD
• Robert Wolfe, FNP

  • Family Nurse Practitioner
  • Prescott, AZ
  • NPI 1023660065
  Medicare reassignment Care Compare group NPD
• Frank Bly Hatch, D.C.

  • Chiropractor
  • Surprise, AZ
  • NPI 1235297144
  Medicare reassignment NPD

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

{
    "created_epoch": "1679529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679529600000",
    "number": "1306549837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18761 N REEMS RD STE 400",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853748646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18761 N REEMS RD STE 400",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853748646",
            "telephone_number": "623-583-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE TANK MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-23",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A",
        "authorized_official_last_name": "WOODSIDE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-583-9180"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Westside Internal Medicine PC
• Matthew Wetmore, AUD
• Stephanie Marcia Wheeler
• Whispering Palms Medical Inc (Phoenix Family Medical Clinic)
• Vanessa Whitchurch, OTR/L
• Angela Marie White, RDH
• Barbara Ann White, LMT, MMP
• Jana Hollyann White, FNP
• Jill Deanne White, MS, LIAC
• Mariana White, APN

• Family Medicine Physician in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.