Basic Information
| Provider Information | |||||||||
| NPI: | 1144742768 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WHITE RIVER HEALTH SYSTEM INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE DIAGNOSTIC CLINIC AT WRMC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3443 HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725018820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706981635 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3443 HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725018820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706981635 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | COSSEY | ||||||||
| AuthorizedOfficialFirstName: | BROOK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACT COMPLIANCE SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 8707935504 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.