Provider Demographics
NPI:1023065117
Name:COMMUNITY MEDICAL CENTER OF IZARD COUNTY
Entity type:Organization
Organization Name:COMMUNITY MEDICAL CENTER OF IZARD COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
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 1:203 TATE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-8237
Mailing Address - Country:US
Mailing Address - Phone:870-368-1911
Mailing Address - Fax:870-368-1910
Practice Address - Street 1:203 TATE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556-8237
Practice Address - Country:US
Practice Address - Phone:870-368-1911
Practice Address - Fax:870-368-1910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEDICAL CENTER OF IZARD COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-27
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
AR175237729Medicaid
AR5B958OtherBCBS
AR175237729Medicaid
AR5G879Medicare PIN