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General NPI Number Information
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NPI Number | 1104642354
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Entity Type | Organization
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Legal Business Name | WHITE RIVER HEALTH SYSTEM, INC.
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 197 HOSPITAL DR STE B
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City | CHEROKEE VILLAGE
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State | AR
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Zip | 72529-7315
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Country | US
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Telephone | 870-257-5118
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Fax | 870-257-6215
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Provider Business Mailing Address
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Address Line | 1710 HARRISON ST
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City | BATESVILLE
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State | AR
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Zip | 72501-7303
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Country | US
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Telephone | 870-262-5545
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Fax | 870-262-6571
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT SPECIALIST
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Name | SHAWNA BAXTER
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Credential |
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Telephone | 870-257-5118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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