Basic Information
| Provider Information | |||||||||
| NPI: | 1952338527 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY MEDICAL CENTER OF IZARD COUNTY HOME HEALTH AND HOSPICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 GRASSE ST | ||||||||
| Address2: | |||||||||
| City: | CALICO ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725190438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702973738 | ||||||||
| FaxNumber: | 8702973739 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 GRASSE ST. | ||||||||
| Address2: | |||||||||
| City: | CALICO ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725190438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702973738 | ||||||||
| FaxNumber: | 8702973739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 11/05/2007 | ||||||||
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| AuthorizedOfficialLastName: | RICHMOND | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8702972400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 17046 | 01 | AR | BLUE CROSS PROVIDER NUMBE | OTHER |