Provider Demographics
NPI:1144609751
Name:WHITE RIVER HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM, INC.
Other - Org Name:WRMC INTERNAL MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-262-1440
Mailing Address - Street 1:12 HOSPITAL CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 HOSPITAL CIR
Practice Address - Street 2:SUITE B
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7326
Practice Address - Country:US
Practice Address - Phone:870-262-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty