| Lakeside Walk-in Clinic Pllc | |
|
2230 Malvern Ave Ste E Hot Springs AR 71901-8000 | |
| (501) 781-3612 | |
| (501) 781-3618 |
| Full Name | Lakeside Walk-in Clinic Pllc |
|---|---|
| Speciality | General Practice |
| Location | 2230 Malvern Ave Ste E, Hot Springs, Arkansas |
| Authorized Official Name and Position | Ernest R Ennis (OWNER) |
| Authorized Official Contact | 5018447020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Walk-in Clinic Pllc 2230 Malvern Ave Unit 3 Hot Springs AR 71901-8038 Ph: () - | Lakeside Walk-in Clinic Pllc 2230 Malvern Ave Ste E Hot Springs AR 71901-8000 Ph: (501) 781-3612 |
| NPI Number | 1205345154 |
|---|---|
| Provider Enumeration Date | 09/22/2017 |
| Last Update Date | 06/16/2018 |
| Medicare PECOS PAC ID | 3072870526 |
|---|---|
| Medicare Enrollment ID | O20171208000570 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205345154 | NPI | - | NPPES |
| 11111 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (Arkansas) | Primary |
| Provider Name | Karl F Wagenhauser |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699739334 PECOS PAC ID: 0941286298 Enrollment ID: I20040628000110 |
| Provider Name | Ernest R Ennis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851794291 PECOS PAC ID: 1355395336 Enrollment ID: I20141216002433 |
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