| Lakeside School | |
|
360a W Highway 82 Lake Village AR 71653-7501 | |
| (870) 201-2127 | |
| (888) 671-8943 |
| Full Name | Lakeside School |
|---|---|
| Speciality | Clinic/Center |
| Location | 360a W Highway 82, 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 |
|---|---|
| Lakeside School 342 Highway 425 S Monticello AR 71655-4612 Ph: (870) 942-3000 | Lakeside School 360a W Highway 82 Lake Village AR 71653-7501 Ph: (870) 201-2127 |
| NPI Number | 1508303124 |
|---|---|
| Provider Enumeration Date | 01/20/2017 |
| Last Update Date | 03/23/2026 |
| Certification Date | 03/23/2026 |
| Medicare PECOS PAC ID | 5193785590 |
|---|---|
| Medicare Enrollment ID | O20171109000593 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508303124 | NPI | - | NPPES |
| 223565749 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
| 103TB0200X | Psychologist - Cognitive & Behavioral | (NU) | Secondary |
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