Provider Demographics
NPI:1902141377
Name:WHITE RIVER HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM, INC.
Other - Org Name:WHITE RIVER REFERENCE LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEBOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-262-6091
Mailing Address - Street 1:PO BOX 3047
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-3047
Mailing Address - Country:US
Mailing Address - Phone:870-262-1818
Mailing Address - Fax:870-262-3191
Practice Address - Street 1:1700 HARRISON ST
Practice Address - Street 2:SUITE H
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7316
Practice Address - Country:US
Practice Address - Phone:870-262-1818
Practice Address - Fax:870-262-3191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory