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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