Healthcare Provider Details

I. General information

NPI: 1437125366
Provider Name (Legal Business Name): MEDICAL CENTER CLINIC OF IZARD COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 GRASSE STREET
CALICO ROCK AR
72519
US

IV. Provider business mailing address

PO BOX 819
CALICO ROCK AR
72519-0819
US

V. Phone/Fax

Practice location:
  • Phone: 870-297-2475
  • Fax: 870-297-4380
Mailing address:
  • Phone: 870-297-2475
  • Fax: 870-297-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD O. WRIGHT
Title or Position: CHIEF OF STAFF
Credential: M.D.
Phone: 870-297-2475