Organization
WHITE RIVER EMERGENCY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C FALK (VP OF CONTRACTING)
(800) 893-9698
Entity
Organization
Contact information
Practice address
1710 HARRISON ST, BATESVILLE, AR 72501-7303
(800) 893-9698
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
AR
363A00000X
Physician Assistant
—
AR
363L00000X
Nurse Practitioner
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210059002
—
AR
Enumeration date
05/13/2015
Last updated
01/11/2016
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