Provider Demographics
NPI:1972600187
Name:COMMUNITY MEDICAL CENTER OF IZARD COUNTY
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CENTER OF IZARD COUNTY
Other - Org Name:COMMUNITY MEIDCAL CENTER CLINIC OF HORSESHOE BEND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPOLEWSKI
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:870-297-2449
Mailing Address - Fax:870-297-4161
Practice Address - Street 1:805 THIRD ST
Practice Address - Street 2:
Practice Address - City:HORSESHOE BEND
Practice Address - State:AR
Practice Address - Zip Code:72512-3736
Practice Address - Country:US
Practice Address - Phone:870-670-5115
Practice Address - Fax:870-670-4455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEDICAL CENTER OF IZARD COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3931261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F645OtherBCBS
AR175236729Medicaid
AR5F645OtherBCBS
AR043496Medicare Oscar/Certification