Healthcare Provider Details

I. General information

NPI: 1598562233
Provider Name (Legal Business Name): WHITE RIVER HEALTH ANESTHESIA SERVICE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HARRISON ST
BATESVILLE AR
72501-7303
US

IV. Provider business mailing address

PO BOX 649705
DALLAS TX
75264-9705
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-1200
  • Fax: 870-262-6088
Mailing address:
  • Phone: 870-262-1200
  • Fax: 870-262-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SHAWNA IVES
Title or Position: CFO
Credential:
Phone: 870-262-1200