Healthcare Provider Details

I. General information

NPI: 1790439826
Provider Name (Legal Business Name): WHITE RIVER HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MALCOLM AVE
NEWPORT AR
72112-3668
US

IV. Provider business mailing address

16 HOSPITAL CIR STE A
BATESVILLE AR
72501-7343
US

V. Phone/Fax

Practice location:
  • Phone: 870-512-2500
  • Fax:
Mailing address:
  • Phone: 870-262-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER BILLINGSLEY
Title or Position: CONTRACT COMPLIANCE SPECIALIST
Credential:
Phone: 870-262-5545