Healthcare Provider Details

I. General information

NPI: 1811958531
Provider Name (Legal Business Name): WHITE RIVER RURAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WEST WILBUR D MILLS AVE
KENSETT AR
72082
US

IV. Provider business mailing address

623 N 9TH STREET PO BOX 497
AUGUSTA AR
72006
US

V. Phone/Fax

Practice location:
  • Phone: 501-742-5660
  • Fax: 501-742-5900
Mailing address:
  • Phone: 870-347-3300
  • Fax: 870-347-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID RECTOR
Title or Position: CFO
Credential:
Phone: 870-342-3313