1962878207 NPI number — WHITE RIVER HEALTH SYSTEM, INC.

Table of content: (NPI 1962878207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962878207 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:
WHITE RIVER HEALTH FAMILY CARE
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:
1962878207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 VIRGINIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATESVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72501-7329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-793-5356
Provider Business Mailing Address Fax Number:
870-793-7017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 VIRGINIA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATESVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72501-7329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-935-3568
Provider Business Practice Location Address Fax Number:
870-793-7017
Provider Enumeration Date:
08/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BAXTER
Authorized Official First Name:
SHAWNA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER ENROLLMENT SPECIALIST
Authorized Official Telephone Number:
870-262-5545

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com