Provider Demographics
NPI:1770544215
Name:WHITE RIVER RURAL HEALTH CENTER INC
Entity type:Organization
Organization Name:WHITE RIVER RURAL HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-347-3313
Mailing Address - Street 1:623 N 9TH STREET
Mailing Address - Street 2:PO BOX 497
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006
Mailing Address - Country:US
Mailing Address - Phone:870-347-3300
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:2601 SOUTHWEST SQUARE CIRCLE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-802-3511
Practice Address - Fax:870-802-4068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR041857Medicare ID - Type Unspecified