Healthcare Provider Details

I. General information

NPI: 1508021619
Provider Name (Legal Business Name): WHITE RIVER RURAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 HIGHWAY 18 STE B
LAKE CITY AR
72437-9622
US

IV. Provider business mailing address

623 N 9TH ST
AUGUSTA AR
72006-2129
US

V. Phone/Fax

Practice location:
  • Phone: 870-237-1246
  • Fax: 870-237-1248
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-2882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20585
License Number StateAR

VIII. Authorized Official

Name: STEVE COLLIER
Title or Position: CEO
Credential: MD
Phone: 870-347-3304