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Organization
LAKESIDE WALK-IN CLINIC PLLC
Active
Organization
LAKESIDE WALK-IN CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST R ENNIS PA-C (OWNER)
(501) 844-7020
Entity
Organization
Contact information
Practice address
2230 MALVERN AVE STE E, HOT SPRINGS, AR 71901-8000
(501) 781-3612
(501) 781-3618
Mailing address
2230 MALVERN AVE UNIT 3, HOT SPRINGS, AR 71901-8038
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11111
—
AR
Enumeration date
09/22/2017
Last updated
06/16/2018
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