| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 04/20/2006 |
| Last Update Date | 12/09/2015 |
| Medicare PECOS PAC ID | 3274575162 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346252681 PECOS PAC ID: 4587688320 Enrollment ID: I20060120000011 |
| Provider Name | John P Burge |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1851370753 PECOS PAC ID: 8729003751 Enrollment ID: I20060120000021 |
| Provider Name | James C Wright |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053390781 PECOS PAC ID: 6103840947 Enrollment ID: I20060120000040 |
| Provider Name | Christopher M Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578945770 PECOS PAC ID: 3971818139 Enrollment ID: I20150817002236 |
| Provider Name | Nina Deal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427578954 PECOS PAC ID: 6507137999 Enrollment ID: I20170803000695 |
| Provider Name | Nathan A Gladden |
|---|---|
| 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 | |
Lakeside School Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 360 A Highway 82, Lake Village, AR 71653 Phone: 870-201-2127 Fax: 888-671-8943 | |
Mainline Health Systems, Inc 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 |