Lakeside Walk-in Clinic PLLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

LAKESIDE WALK-IN CLINIC PLLC

Practice address

2230 Malvern Ave Ste E
Hot Springs, AR 71901-8000

Phone

(501) 781-3612

Fax

(501) 781-3618

NPI assigned

Sep 22, 2017

Last updated

Jun 16, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ernest R Ennis, PA-CNPI 1851794291

Title

Owner

Phone

(501) 844-7020

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ernest R Ennis, APN

  • Family Nurse Practitioner
  • Hot Springs, AR
  • NPI 1851794291
  Medicare reassignment NPD Authorized official
• Karl F. Wagenhauser, M.D.

  • Emergency Medicine Physician
  • Texarkana, TX
  • NPI 1699739334

  AR

  Medicare reassignment NPD
• Sharon McDaniel, NP-C

  • Family Nurse Practitioner
  • Bryant, AR
  • NPI 1174946149
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1205345154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 MALVERN AVE UNIT 3",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719018038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 MALVERN AVE STE E",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719018000",
            "telephone_number": "501-781-3612",
            "fax_number": "501-781-3618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE WALK-IN CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-22",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "ENNIS",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-844-7020",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11111",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline P Lacy, MS, LPC
• Christine Lai, MD
• Lake Hamilton Family Chiropractic PLLC (Lake Hamilton Family and Sports Chiropractic)
• Lakeside Pharmacy Inc.
• Lakeside School District
• Lakewood Healthcare, Inc.
• Lakewood Therapy and Living Center Opco LLC (Lakewood Therapy And Living Center)
• Virginia Arlette Laliberte, APRN
• Thelma Lamb, MHPP
• Tiara Mary Lamb, MHPP

• General Practice Physician in Hot Springs, AR
• Providers in Hot Springs, AR by specialty
• General Practice Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.