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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