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General NPI Number Information
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NPI Number | 1164222113
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Entity Type | Organization
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Legal Business Name | RIVER VALLEY PRIMARY CARE SERVICES
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 722 HIGHWAY 282 SW
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City | MOUNTAINBURG
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State | AR
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Zip | 72946-4308
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Country | US
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Telephone | 479-369-2086
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | RATCLIFF
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State | AR
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Zip | 72951-0130
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Country | US
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Telephone | 479-431-2057
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JEROME J WHITE
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Credential |
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Telephone | 479-431-2057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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