LAKE VILLAGE CLINIC PA
NPI 1306801212
Clinic/Center - Rural Health in Lake Village, AR

Q: What is Lake Village Clinic PA's NPI number?

The NPI number for Lake Village Clinic PA is 1306801212. It was assigned to this organization in the NPPES registry on April 20, 2006.

Q: What is Lake Village Clinic PA's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Active since April 20, 2006CLIA 04D0693694 · Waiver

2918 LOUIS SESSIONS ST, LAKE VILLAGE, AR 71653(870) 265-5343(870) 265-5686 Get Directions Write a Review

NPPES record last updated: September 27, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 27, 2024, Dec 9, 2015 (2 updates tracked since 2015).

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About Lake Village Clinic Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE VILLAGE CLINIC PA (NPI 1306801212) is a healthcare organization registered as a rural health in Lake Village, Arkansas and active in the NPI registry since April 2006. The organization holds a CLIA Waiver certificate valid through August 7, 2027 and lists Suzanne Howell, Billing Manager, as its authorized official.

NPPES Registry Identity

NPI1306801212

Entity TypeOrganization

Primary Taxonomy261QR1300X

Legal Business NameLAKE VILLAGE CLINIC PA

Location Address2918 LOUIS SESSIONS STLake Village, AR 71653-6049

Mailing Address2918 Louis Sessions StLake Village, AR 71653-6049 · (870) 265-5343 · Fax (870) 265-5686

Phone(870) 265-5343

Fax(870) 265-5686

Organization SubpartNo

Authorized OfficialSuzanne HowellBilling Manager · (870) 265-5343

Enumeration DateApril 20, 2006

Last NPPES UpdateSeptember 27, 20242 updates tracked since enumeration

NPPES CertifiedSeptember 27, 2024

✔ NPI 1306801212 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities

Taxonomy Code261QR1300X

License✔ Licensed in AR · MC0189

Also ListedGeneral PracticeTaxonomy 208D00000X · License MC0189 (AR)

2918 LOUIS SESSIONS ST, Lake Village, AR 71653

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Other Identifiers 2

Medicaid101409002AR

Medicaid127181729AR

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Arkansas Blue Cross and Blue Shield, Health Advantage, Octave and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 04D0693694

Lake Village Clinic, PA · Lake Village, AR

Active · expires Aug 7, 2027

CLIA Number04D0693694

Laboratory TypePhysician Office

Certificate Effective DateAugust 8, 2025

Certificate Expiration DateAugust 7, 2027

Laboratory DirectorJames C. Wright

Laboratory Phone(870) 265-5343

Laboratory LocationLake Village Clinic, PA2918 Louis Sessions Street, Lake Village, AR 71653

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JO ANNE GREGORY MD

Family Medicine