Provider Demographics
NPI:1508021619
Name:WHITE RIVER RURAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WHITE RIVER RURAL HEALTH CENTER, INC.
Other - Org Name:COMMUNITY DRUG STORE OF LAKE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-347-3304
Mailing Address - Street 1:623 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-2129
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-2882
Practice Address - Street 1:1009 HIGHWAY 18
Practice Address - Street 2:STE B
Practice Address - City:LAKE CITY
Practice Address - State:AR
Practice Address - Zip Code:72437-9622
Practice Address - Country:US
Practice Address - Phone:870-237-1246
Practice Address - Fax:870-237-1248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE RIVER RURAL HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-29
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
ARAR205853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0422903OtherNCPDP PROVIDER IDENTIFICATION NUMBER