Healthcare Provider Details

I. General information

NPI: 1255410296
Provider Name (Legal Business Name): WHITE RIVER HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 HARRISON ST
BATESVILLE AR
72501-7219
US

IV. Provider business mailing address

PO BOX 2579
BATESVILLE AR
72503-2579
US

V. Phone/Fax

Practice location:
  • Phone: 870-698-1616
  • Fax:
Mailing address:
  • Phone: 870-698-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA RENAE MELTON
Title or Position: CLINIC SUPERVISOR
Credential:
Phone: 870-262-6039