Provider Demographics
NPI:1790842078
Name:WHITE RIVER HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM, INC
Other - Org Name:WRMC REFERENCE LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEBOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-262-6091
Mailing Address - Street 1:1710 HARRISON ST
Mailing Address - Street 2:P.O. BOX 3890
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
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:870-262-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory