| Lavaca Wellness Center | |
|
603 S Division St Lavaca AR 72941-4129 | |
| (479) 431-2050 | |
| (479) 431-2058 |
| Full Name | Lavaca Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 603 S Division St, Lavaca, Arkansas |
| Authorized Official Name and Position | Jerome J White (EX. DIRECTOR) |
| Authorized Official Contact | 4794312057 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lavaca Wellness Center Po Box 130 Ratcliff AR 72951-0130 Ph: (479) 431-2050 | Lavaca Wellness Center 603 S Division St Lavaca AR 72941-4129 Ph: (479) 431-2050 |
| NPI Number | 1902452345 |
|---|---|
| Provider Enumeration Date | 08/12/2019 |
| Last Update Date | 02/01/2021 |
| Medicare PECOS PAC ID | 0042274276 |
|---|---|
| Medicare Enrollment ID | O20191016001463 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902452345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Lavaca Family Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1000 W Main St, Lavaca, AR 72941 Phone: 479-674-9181 | |
Lavaca Wellness Clinic, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 603 S Division St, Lavaca, AR 72941 Phone: 479-674-9181 Fax: 479-674-8105 |