Organization Name: | LAKE VILLAGE CLINIC PA |
NPI Number: | 1306801212 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUZANNE HOWELL (BILLING MANAGER) |
Mailing Address: | 2918 Louis Sessions St Lake Village |
State: | AR US |
Postal Code: | 716536049 |
Phone Number: | 8702655343 |
Fax Number: | 8702655686 |
NPI Enumeration Date: | 04/20/2006 |
NPI Last Update Date: | 12/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MC0189 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |