Healthcare Provider Details

I. General information

NPI: 1881489789
Provider Name (Legal Business Name): WHITE RIVER HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 VIRGINIA DR STE A
BATESVILLE AR
72501-7317
US

IV. Provider business mailing address

1710 HARRISON ST
BATESVILLE AR
72501-7303
US

V. Phone/Fax

Practice location:
  • Phone: 870-698-1846
  • Fax: 870-793-2627
Mailing address:
  • Phone: 870-262-5545
  • Fax: 870-262-6966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

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