Provider Demographics
NPI:1295817260
Name:WHITE RIVER HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM, INC
Other - Org Name:WHITE RIVER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-262-1380
Mailing Address - Street 1:1710 HARRISON ST
Mailing Address - Street 2:P.O. BOX 2197
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7303
Mailing Address - Country:US
Mailing Address - Phone:870-262-6171
Mailing Address - Fax:870-262-6088
Practice Address - Street 1:1710 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7303
Practice Address - Country:US
Practice Address - Phone:870-262-6171
Practice Address - Fax:870-262-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR418273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04S119Medicare ID - Type UnspecifiedPROVIDER NUMBER