Healthcare Provider Details

I. General information

NPI: 1831398338
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTER OF IZARD COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GRASSE STREET
CALICO ROCK AR
72519-0438
US

IV. Provider business mailing address

PO BOX 438
CALICO ROCK AR
72519-0438
US

V. Phone/Fax

Practice location:
  • Phone: 870-297-2403
  • Fax:
Mailing address:
  • Phone: 870-297-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPTA1837
License Number StateAR

VIII. Authorized Official

Name: MRS. ANGELA GARGUS
Title or Position: CFO
Credential:
Phone: 870-297-2449