Provider Demographics
NPI:1851470371
Name:WHITE RIVER HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM, INC.
Other - Org Name:THE WOMEN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-262-6039
Mailing Address - Street 1:1215 SIDNEY ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7203
Mailing Address - Country:US
Mailing Address - Phone:870-262-2000
Mailing Address - Fax:
Practice Address - Street 1:1215 SIDNEY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7203
Practice Address - Country:US
Practice Address - Phone:870-262-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty