Provider Demographics
NPI:1427149814
Name:WHITE RIVER HEALTH SYSTEM, INC.
Entity type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-262-5545
Mailing Address - Street 1:1710 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7303
Mailing Address - Country:US
Mailing Address - Phone:870-269-4361
Mailing Address - Fax:870-269-3093
Practice Address - Street 1:2106 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-6439
Practice Address - Country:US
Practice Address - Phone:870-262-5056
Practice Address - Fax:870-262-6088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE RIVER HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112094002Medicaid
AR157571105Medicaid
AR57891OtherBCBS
AR57891OtherBCBS