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Organization
OAK PARK MEDICAL C,LINIC, P.A.
Active
Organization
OAK PARK MEDICAL C,LINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LACKEY GENE MOODY M.D. (CEO)
(870) 793-9887
Entity
Organization
Contact information
Practice address
1301 WHITE DR, BATESVILLE, AR 72501-9467
(870) 793-6887
(870) 793-8085
Mailing address
PO BOX 2335, BATESVILLE, AR 72503-2335
(870) 793-6887
(870) 793-8085
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C-4126
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57250
BLUE CROSS
AR
Enumeration date
03/21/2006
Last updated
08/22/2020
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