LAVACA WELLNESS CLINIC P.A. NPI 1821390287

NPI Information

  • NPI: 1821390287
  • Provider Name: LAVACA WELLNESS CLINIC, P.A.
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • CLIA Number: 04D2172054
  • Address: 603 S DIVISION ST
    LAVACA, AR
    ZIP 72941
  • Phone: (479) 674-9181

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NPI Details

LAVACA WELLNESS CLINIC, P.A. is a primary care clinic center in Lavaca, AR. LAVACA WELLNESS CLINIC, P.A. NPI is 1821390287. The provider is registered as an organization entity type.

The provider's business location address is:

603 S DIVISION ST
LAVACA, AR
ZIP 72941-129
Phone: (479) 674-9181
Fax: (479) 674-8105

The provider's authorized official is Robert E. Sanders .
The authorized official title is Owner and has the following contact phone number (479) 462-7203.

The CLIA number assigned to this NPI record is 04D2172054 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 11/17/2010 and was last updated on 11/17/2010.

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
1261QP2300XClinic/CenterPrimary CareYes

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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