Healthcare Provider Details

I. General information

NPI: 1356565428
Provider Name (Legal Business Name): WHITE RIVER HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 HARRISON ST 1699 HARRISON ST.
BATESVILLE AR
72501-7302
US

IV. Provider business mailing address

1699 HARRISON ST P.O. BOX 2197
BATESVILLE AR
72501-7302
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-1271
  • Fax: 870-262-6013
Mailing address:
  • Phone: 870-262-1271
  • Fax: 870-262-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number StateAR

VIII. Authorized Official

Name: MRS. MAXINE S HALL
Title or Position: OFFICE MANAGER
Credential:
Phone: 870-262-1271