Provider Demographics
NPI:1902862915
Name:WHITE RIVER HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM, INC
Other - Org Name:STONE COUNTY MEDICAL CENTER SWING BED
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:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-0510
Mailing Address - Country:US
Mailing Address - Phone:870-626-5056
Mailing Address - Fax:870-262-6088
Practice Address - Street 1:2106 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-6439
Practice Address - Country:US
Practice Address - Phone:870-269-4361
Practice Address - Fax:870-269-3093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE RIVER HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-26
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1Z310OtherBCBS
AR1Z310OtherBCBS
AR04Z310Medicare Oscar/Certification
AR04Z310Medicare PIN