Provider Demographics
NPI:1245412030
Name:IZARD COUNTY MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:IZARD COUNTY MEDICAL CENTER, LLC
Other - Org Name:COMMUNITY MEDICAL CENTER CLINIC OF CALICO ROCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO/CFO
Authorized Official - Phone:870-297-2400
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:CALICO ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72519-0438
Mailing Address - Country:US
Mailing Address - Phone:870-297-3726
Mailing Address - Fax:870-297-4161
Practice Address - Street 1:61 GRASSE ST
Practice Address - Street 2:
Practice Address - City:CALICO ROCK
Practice Address - State:AR
Practice Address - Zip Code:72519-7013
Practice Address - Country:US
Practice Address - Phone:870-287-3726
Practice Address - Fax:870-297-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178732729Medicaid
AR5C560OtherBCBS
AR178732729Medicaid
AR5C560Medicare PIN