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General NPI Number Information
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NPI Number | 1982277265
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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 | 07/23/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 106 N HILL ST
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City | CLARKSVILLE
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State | AR
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Zip | 72830-2961
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Country | US
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Telephone | 479-668-3292
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Fax | 479-668-3293
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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