1962878207 NPI number — WHITE RIVER HEALTH SYSTEM, INC.

Table of content: CARALYNN DELLA RIPA RD (NPI 1649624321)

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:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 HARRISON ST
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:
72501-7303
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)





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