Lake Village Clinic Pa | |
2918 Louis Sessions St Lake Village AR 71653-6049 | |
(870) 265-5343 | |
(870) 265-5686 |
Full Name | Lake Village Clinic Pa |
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Speciality | Clinic/Center |
Location | 2918 Louis Sessions St, Lake Village, Arkansas |
Authorized Official Name and Position | Suzanne Howell (BILLING MANAGER) |
Authorized Official Contact | 8702655343 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lake Village Clinic Pa 2918 Louis Sessions St Lake Village AR 71653-6049 Ph: (870) 265-5343 | Lake Village Clinic Pa 2918 Louis Sessions St Lake Village AR 71653-6049 Ph: (870) 265-5343 |
NPI Number | 1306801212 |
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Provider Enumeration Date | 04/20/2006 |
Last Update Date | 09/27/2024 |
Medicare PECOS PAC ID | 3274575162 |
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Medicare Enrollment ID | O20050601001036 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306801212 | NPI | - | NPPES |
101409002 | Medicaid | AR | |
127181729 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | MC0189 (Arkansas) | Secondary |
261QR1300X | Clinic/center - Rural Health | MC0189 (Arkansas) | Primary |
Provider Name | Jo Anne Gregory |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1346252681 PECOS PAC ID: 4587688320 Enrollment ID: I20060120000011 |
Provider Name | John P Burge |
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Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1851370753 PECOS PAC ID: 8729003751 Enrollment ID: I20060120000021 |
Provider Name | James C Wright |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1053390781 PECOS PAC ID: 6103840947 Enrollment ID: I20060120000040 |
Provider Name | Christopher M Johnson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578945770 PECOS PAC ID: 3971818139 Enrollment ID: I20150817002236 |
Provider Name | Nina Deal |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427578954 PECOS PAC ID: 6507137999 Enrollment ID: I20170803000695 |
Provider Name | Nathan A Gladden |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619545829 PECOS PAC ID: 9638573504 Enrollment ID: I20210814000333 |
Provider Name | John Parks |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1942528518 PECOS PAC ID: 5890923361 Enrollment ID: I20211115000466 |
Chicot Memorial Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2729 Hwy 65 & 82 S, Lake Village, AR 71653 Phone: 870-265-5351 Fax: 870-265-2091 | |
Chicot Memorial Medical Center Womens Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2729 Hwy 65 & 82 S, Lake Village, AR 71653 Phone: 870-265-5351 Fax: 870-265-2091 | |
Southeast Rural Health Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 608 S Highway 65 82, Lake Village, AR 71653 Phone: 870-265-4333 Fax: 318-665-9950 | |
Ob Lake Village Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2729 Us 65, Lake Village, AR 71653 Phone: 870-466-4987 Fax: 855-926-7383 | |
Russell Medical Services Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5071 Highway 82 E, Lake Village, AR 71653 Phone: 870-515-1289 | |
The Functional Pharmacist Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 Main St, Lake Village, AR 71653 Phone: 870-265-6603 |