LAKE VILLAGE CLINIC PA NPI 1306801212

NPI Information

LAKE VILLAGE CLINIC PA is a rural health clinic center in Lake Village, AR. LAKE VILLAGE CLINIC PA NPI is 1306801212. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2918 LOUIS SESSIONS ST
LAKE VILLAGE, AR
ZIP 71653-049
Phone: (870) 265-5343
Fax: (870) 265-5686

The provider's authorized official is Suzanne Howell .
The authorized official title is Billing Manager and has the following contact phone number (870) 265-5343.

The CLIA number assigned to this NPI record is 04D0693694 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/20/2006 and was last updated on 12/9/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.