NPIMap

Organization Active NPI

White Mountain Medical Consultants LLC

  • Family Medicine Physician
  • Lakeside, AZ
National Provider Identifier
1508338831
Registry record updated Dec 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WHITE MOUNTAIN MEDICAL CONSULTANTS LLC
Practice address
3401 Lockwood Dr
Lakeside, AZ 85929-5613
Phone
(928) 368-2060
Fax
(928) 368-2061
NPI assigned
Dec 27, 2018
Last updated
Dec 27, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2018

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

Authorized official

Name
Dr. Brian William Goodman, DO
Title
Tax Id, Practice Owner
Phone
(480) 244-6035

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3401 Lockwood Dr
Lakeside, AZ 85929-5613

Mailing address

781 E Mills PL
Show Low, AZ 85901-6026
Phone (480) 244-6035

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1545868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545868800000",
    "number": "1508338831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 E MILLS PL",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859016026",
            "telephone_number": "480-244-6035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 LOCKWOOD DR",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295613",
            "telephone_number": "928-368-2060",
            "fax_number": "928-368-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE MOUNTAIN MEDICAL CONSULTANTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-27",
        "last_updated": "2018-12-27",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "TAX ID, PRACTICE OWNER",
        "authorized_official_telephone_number": "480-244-6035",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeside, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2018; 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.