Healthcare Provider Details

I. General information

NPI: 1578543070
Provider Name (Legal Business Name): WHITE RIVER HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 E RIVER DR
STRAWBERRY AR
72469-8016
US

IV. Provider business mailing address

1710 HARRISON ST
BATESVILLE AR
72501-7303
US

V. Phone/Fax

Practice location:
  • Phone: 870-528-4081
  • Fax: 870-528-3286
Mailing address:
  • Phone: 870-528-4081
  • Fax: 870-528-3286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAWNA BAXTER
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 870-262-5545