Organization
LAKE VILLAGE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE HOWELL (BILLING MANAGER)
(870) 265-5343
Entity
Organization
Contact information
Practice address
2918 LOUIS SESSIONS ST, LAKE VILLAGE, AR 71653-6049
(870) 265-5343
(870) 265-5686
Mailing address
2918 LOUIS SESSIONS ST, LAKE VILLAGE, AR 71653-6049
(870) 265-5343
(870) 265-5686
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
MC0189
AR
261QR1300X
Rural Health Clinic/Center
Primary
MC0189
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101409002
—
AR
05
—
127181729
—
AR
Enumeration date
04/20/2006
Last updated
09/27/2024
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