Lakeside School | |
360 A Highway 82 Lake Village AR 71653 | |
(870) 201-2127 | |
(888) 671-8943 |
Full Name | Lakeside School |
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Speciality | Clinic/Center |
Location | 360 A Highway 82, Lake Village, Arkansas |
Authorized Official Name and Position | Gary Allan Nichols (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 8705385414 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lakeside School Po Box 509 Dermott AR 71638-0509 Ph: (870) 538-5414 | Lakeside School 360 A Highway 82 Lake Village AR 71653 Ph: (870) 201-2127 |
NPI Number | 1508303124 |
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Provider Enumeration Date | 01/20/2017 |
Last Update Date | 08/30/2022 |
Medicare PECOS PAC ID | 5193785590 |
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Medicare Enrollment ID | O20171109000593 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508303124 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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