Provider Demographics
NPI:1134298268
Name:WHITE RIVER HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM, INC.
Other - Org Name:THE CHILDREN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-262-6039
Mailing Address - Street 1:PO BOX 2679
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-2679
Mailing Address - Country:US
Mailing Address - Phone:870-262-2000
Mailing Address - Fax:
Practice Address - Street 1:1700 HARRISON ST
Practice Address - Street 2:SUITE N
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7316
Practice Address - Country:US
Practice Address - Phone:870-262-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty