# LAKE CONVENIENCE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174516249
- **Authorized official:** THOMAS HENRY GARRETT MD (DOCTOR)
- **Authorized official phone:** (573) 398-1560

## Contact information

- **Practice address:** 100 COLLEGE BLVD, LAKE OZARK, MO 65049-8690
- **Practice address phone:** (573) 348-1560
- **Practice address fax:** (573) 348-5088
- **Mailing address:** 100 COLLEGE BLVD, LAKE OZARK, MO 65049-8690
- **Mailing address phone:** (573) 348-1560
- **Mailing address fax:** (573) 348-5088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/24/2005
- **Last updated:** 07/03/2008