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General NPI Number Information
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NPI Number | 1275513780
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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 | 01/19/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 1995 HARRISON ST
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City | BATESVILLE
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State | AR
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Zip | 72501-7309
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Country | US
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Telephone | 870-793-2540
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Fax | 870-698-1262
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Provider Business Mailing Address
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Address Line | 1995 HARRISON ST
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City | BATESVILLE
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State | AR
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Zip | 72501-7309
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Country | US
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Telephone | 870-793-2540
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Fax | 870-698-1262
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | LISA R MELTON
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Credential |
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Telephone | 870-262-6039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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