MEDICARE: WHITE RIVER HEALTH SYSTEM INC

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	261QR1300X	Rural Health 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	:	1568442127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE RIVER HEALTH SYSTEM INC

Provider Business Mailing Address
First Line	:	1710 HARRISON ST
Second Line	:
City	:	BATESVILLE
State	:	AR
Zip	:	72501-7303
Country	:	US
Telephone Number	:	870-262-5545
Fax Number	:	870-262-6571

Provider Business Practice Location Address
First Line	:	301 S MAIN ST
Second Line	:
City	:	CAVE CITY
State	:	AR
Zip	:	72521-9476
Country	:	US
Telephone Number	:	870-283-5353
Fax Number	:	870-283-5988

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT
Name	:	SHAWNA BAXTER
Credential	:
Telephone Number	:	870-262-5545

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	04/29/2024

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Directions to “WHITE RIVER HEALTH SYSTEM INC ” Practice Location

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