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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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