# OAK PARK MEDICAL C,LINIC, P.A.

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

## Provider details

- **NPI number:** 1902865579
- **Authorized official:** DR. LACKEY GENE MOODY M.D. (CEO)
- **Authorized official phone:** (870) 793-9887

## Contact information

- **Practice address:** 1301 WHITE DR, BATESVILLE, AR 72501-9467
- **Practice address phone:** (870) 793-6887
- **Practice address fax:** (870) 793-8085
- **Mailing address:** PO BOX 2335, BATESVILLE, AR 72503-2335
- **Mailing address phone:** (870) 793-6887
- **Mailing address fax:** (870) 793-8085

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | C-4126 | AR | Yes |

## Other

- **Enumeration date:** 03/21/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 57250 | BLUE CROSS | AR |