Provider Demographics
NPI:1063535250
Name:WHITE RIVER HEALTH SYSTEM
Entity type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-262-1271
Mailing Address - Street 1:1699 HARRISON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7302
Mailing Address - Country:US
Mailing Address - Phone:870-262-1271
Mailing Address - Fax:870-262-6013
Practice Address - Street 1:1699 HARRISON ST
Practice Address - Street 2:SUITE A
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7302
Practice Address - Country:US
Practice Address - Phone:870-262-1271
Practice Address - Fax:870-262-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR127293721283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127293721Medicaid