RIVERSIDE MEDICAL CLINIC NPI 1811206923

NPI Information

  • NPI: 1811206923
  • Provider Name: RIVERSIDE MEDICAL CLINIC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 04D2015798
  • Address: 803 HWY 18
    LAKE CITY, AR
    ZIP 72347
  • Phone: (870) 237-1055

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NPI Details

RIVERSIDE MEDICAL CLINIC is a family medicine in Lake City, AR. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. RIVERSIDE MEDICAL CLINIC NPI is 1811206923. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

803 HWY 18
LAKE CITY, AR
ZIP 72347-505
Phone: (870) 237-1055
Fax: (870) 237-1054

The provider's authorized official is Tommy Wagner .
The authorized official title is Owner and has the following contact phone number (870) 561-3300.

The CLIA number assigned to this NPI record is 04D2015798 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/7/2010 and was last updated on 8/2/2011.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

Other Identifiers

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

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
15G721MEDICARE PINARKANSAS
2187113002MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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