Healthcare Provider Details

I. General information

NPI: 1578872297
Provider Name (Legal Business Name): WHITE RIVER HEALTH SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HARRISON ST
BATESVILLE AR
72501-7303
US

IV. Provider business mailing address

1710 HARRISON ST
BATESVILLE AR
72501-7303
US

V. Phone/Fax

Practice location:
  • Phone: 702-621-2408
  • Fax: 870-262-6541
Mailing address:
  • Phone: 870-262-1240
  • Fax: 870-262-6541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAWNA BAXTER
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 870-262-5545