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Organization
WHITE RIVER HEALTH SYSTEM,INC.
Active
Organization
WHITE RIVER HEALTH SYSTEM,INC.
Active
Other names
NORTH COMPLEX OUTPATIENT SURGERY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY BEBOW (CEO)
(870) 262-6091
Entity
Organization
Contact information
Practice address
197 HOSPITAL DR, SUITE D, CHEROKEE VILLAGE, AR 72529-7314
(870) 257-6070
(870) 257-7667
Mailing address
197 HOSPITAL DR, SUITE D, CHEROKEE VILLAGE, AR 72529-7314
(870) 257-6061
(870) 257-7667
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11076
MEDICARE PTAN
AR
01
—
15386
CERTIFICATION
AR
05
—
175016128
—
AR
01
—
AR4463
STATE LICENSE
AR
Enumeration date
11/16/2007
Last updated
07/08/2013
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