Provider Demographics
NPI:1235101601
Name:WHITE RIVER HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM, INC.
Other - Org Name:WHITE RIVER HEALTH NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT COMPLIANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-262-5545
Mailing Address - Street 1:1699 HARRISON ST STE D
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7318
Mailing Address - Country:US
Mailing Address - Phone:870-262-5545
Mailing Address - Fax:870-262-3253
Practice Address - Street 1:1699 HARRISON ST
Practice Address - Street 2:SUITE D
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7302
Practice Address - Country:US
Practice Address - Phone:870-793-5200
Practice Address - Fax:870-793-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152070002Medicaid
AR5C898Medicare ID - Type Unspecified