| Ob Lake Village | |
|
2729 Us 65 Lake Village AR 71653 | |
| (870) 466-4987 | |
| (855) 926-7383 |
| Full Name | Ob Lake Village |
|---|---|
| Speciality | Clinic/Center |
| Location | 2729 Us 65, Lake Village, Arkansas |
| Authorized Official Name and Position | Gary Allan Nichols (CEO) |
| Authorized Official Contact | 8709423000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ob Lake Village Po Box 509 Dermott AR 71638-0509 Ph: (870) 942-3000 | Ob Lake Village 2729 Us 65 Lake Village AR 71653 Ph: (870) 466-4987 |
| NPI Number | 1548949852 |
|---|---|
| Provider Enumeration Date | 07/13/2023 |
| Last Update Date | 07/11/2024 |
| Medicare PECOS PAC ID | 5193785590 |
|---|---|
| Medicare Enrollment ID | O20240104004147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548949852 | NPI | - | NPPES |
| 315451749 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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