Provider Demographics
NPI:1912949769
Name:METRO SPRINGDALE MED CENTER INC
Entity Type:Organization
Organization Name:METRO SPRINGDALE MED CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-200-4424
Mailing Address - Street 1:1670 W SUNSET AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5235
Mailing Address - Country:US
Mailing Address - Phone:479-725-2555
Mailing Address - Fax:479-725-2562
Practice Address - Street 1:1670 W SUNSET AVE
Practice Address - Street 2:STE B
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5136
Practice Address - Country:US
Practice Address - Phone:479-725-2555
Practice Address - Fax:479-725-2562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR55992Medicare ID - Type UnspecifiedMEDICARE
ARD64222Medicare UPIN