1902862915 NPI number — WHITE RIVER HEALTH SYSTEM, INC

Table of content: (NPI 1902862915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902862915 NPI number — WHITE RIVER HEALTH SYSTEM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE RIVER HEALTH SYSTEM, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STONE COUNTY MEDICAL CENTER SWING BED
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902862915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72560-0510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-626-5056
Provider Business Mailing Address Fax Number:
870-262-6088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2106 E. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN VIEW
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72560-6439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-269-4361
Provider Business Practice Location Address Fax Number:
870-269-3093
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BILLINGSLEY
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACT COMPLIANCE SPECIALIST
Authorized Official Telephone Number:
870-262-5545

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1Z310 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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