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RIVERSIDE MEDICAL CLINIC
NPI 1811206923
Family Medicine in Lake City, AR

Active since October 07, 2010CLIA 04D2015798 · Waiver
803 HWY 18, LAKE CITY, AR 72347(870) 237-1055(870) 237-1054 Get Directions Write a Review

NPPES record last updated: August 2, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Riverside Medical Clinic NPPES

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

RIVERSIDE MEDICAL CLINIC (NPI 1811206923) is a healthcare organization registered as a family medicine in Lake City, Arkansas and active in the NPI registry since October 2010. The organization holds a CLIA Waiver certificate valid through November 3, 2026 and lists Tommy Wagner, Owner, as its authorized official.

NPPES Registry Identity

NPI1811206923
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameRIVERSIDE MEDICAL CLINIC
Location Address803 HWY 18Lake City, AR 72347-0505
Mailing AddressPo Box 910Manila, AR 72442-0910 · (870) 561-3300 · Fax (870) 561-3307
Phone(870) 237-1055
Fax(870) 237-1054
Organization SubpartNo
Authorized OfficialTommy WagnerOwner · (870) 561-3300
Enumeration DateOctober 7, 2010
Last NPPES UpdateAugust 2, 2011
✔ NPI 1811206923 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
803 HWY 18, Lake City, AR 72347
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Other Identifiers 2

Medicare PIN5G721AR
Medicaid187113002AR

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Louisiana Healthcare Connections 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 04D2015798

Riverside Medical Clinic · Lake City, AR
Active · expires Nov 3, 2026
CLIA Number04D2015798
Laboratory TypePhysician Office
Certificate Effective DateNovember 4, 2024
Certificate Expiration DateNovember 3, 2026
Laboratory DirectorDr. Tommy W. Wagner
Laboratory Phone(870) 237-1055
Laboratory LocationRiverside Medical Clinic803 Hwy 18, Lake City, AR 72437
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Riverside Medical Clinic's NPI number?

The NPI number for Riverside Medical Clinic is 1811206923. It was assigned to this organization in the NPPES registry on October 7, 2010.

Where is Riverside Medical Clinic located?

Riverside Medical Clinic is located at 803 Hwy 18, Lake City, AR 72347. The listed phone number is (870) 237-1055.

What is Riverside Medical Clinic's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Riverside Medical Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 04D2015798) is associated with this NPI, valid through November 3, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Riverside Medical Clinic accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and Ambetter from Superior HealthPlan and 2 other insurers list Riverside Medical Clinic as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Riverside Medical Clinic was last updated on August 2, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.