Provider Demographics
NPI:1144742768
Name:WHITE RIVER HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM INC
Other - Org Name:THE DIAGNOSTIC CLINIC AT WRMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT COMPLIANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BROOK
Authorized Official - Middle Name:
Authorized Official - Last Name:COSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-793-5504
Mailing Address - Street 1:3443 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8820
Mailing Address - Country:US
Mailing Address - Phone:870-698-1635
Mailing Address - Fax:
Practice Address - Street 1:3443 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-8820
Practice Address - Country:US
Practice Address - Phone:870-698-1635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty