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General NPI Number Information
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NPI Number | 1538254032
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Entity Type | Organization
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Legal Business Name | WHITE RIVER EMS, INC.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 1811 NORTH PECAN STREET
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City | NEWPORT
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State | AR
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Zip | 72112
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Country | US
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Telephone | 870-523-3908
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Fax | 870-523-8974
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Provider Business Mailing Address
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Address Line | 1811 NORTH PECAN STREET
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City | NEWPORT
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State | AR
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Zip | 72112
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Country | US
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Telephone | 870-523-3908
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Fax | 870-523-8974
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY WILTON PADGET
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Credential |
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Telephone | 870-734-3366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 213
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 214
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License Number State | AR
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