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General NPI Number Information
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NPI Number | 1235101601
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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 | 02/01/2006
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 1699 HARRISON ST SUITE D
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City | BATESVILLE
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State | AR
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Zip | 72501-7302
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Country | US
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Telephone | 870-793-5200
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Fax | 870-793-5277
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Provider Business Mailing Address
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Address Line | 1699 HARRISON ST STE D
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City | BATESVILLE
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State | AR
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Zip | 72501-7318
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Country | US
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Telephone | 870-262-5545
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Fax | 870-262-3253
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT
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Name | SHAWNA BAXTER
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Credential |
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Telephone | 870-262-5545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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