| Riverside Medical Clinic | |
|
803 Hwy 18 Lake City AR 72347-0505 | |
| (870) 237-1055 | |
| (870) 237-1054 |
| Full Name | Riverside Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 803 Hwy 18, Lake City, Arkansas |
| Authorized Official Name and Position | Tommy Wagner (OWNER) |
| Authorized Official Contact | 8705613300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Medical Clinic Po Box 910 Manila AR 72442-0910 Ph: (870) 561-3300 | Riverside Medical Clinic 803 Hwy 18 Lake City AR 72347-0505 Ph: (870) 237-1055 |
| NPI Number | 1811206923 |
|---|---|
| Provider Enumeration Date | 10/07/2010 |
| Last Update Date | 08/02/2011 |
| Medicare PECOS PAC ID | 5597944157 |
|---|---|
| Medicare Enrollment ID | O20110127001167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811206923 | NPI | - | NPPES |
| 187113002 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tommy Wayne Wagner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952385064 PECOS PAC ID: 2264422195 Enrollment ID: I20040513000982 |
| Provider Name | Kristi Qualls Price |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639136609 PECOS PAC ID: 6204810773 Enrollment ID: I20040614001504 |
| Provider Name | Danna Scott Deaton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578667010 PECOS PAC ID: 0840267415 Enrollment ID: I20040913001412 |
| Provider Name | Kristy Lynn Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134143472 PECOS PAC ID: 0345208815 Enrollment ID: I20041230000119 |
| Provider Name | Lacey Diane Poe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205069630 PECOS PAC ID: 3476609777 Enrollment ID: I20090928000401 |
| Provider Name | Andrea L Read |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1174799258 PECOS PAC ID: 2466618590 Enrollment ID: I20120718000284 |
| Provider Name | Kelsi B Price |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427738095 PECOS PAC ID: 4981057544 Enrollment ID: I20240130003282 |
Arcare Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1009 Highway 18, Lake City, AR 72437 Phone: 870-237-9928 Fax: 978-327-7971 | |
Jordan Consulting Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 119 Cobean Blvd, Lake City, AR 72437 Phone: 870-819-7075 |