NPIMap

Organization Active NPI

Chicot Memorial Medical Center

Doing business as Lake Village Clinic

  • Rural Health Clinic/Center
  • Lake Village, AR
National Provider Identifier
1821953092
Registry record updated Dec 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHICOT MEMORIAL MEDICAL CENTER
Doing business as
Lake Village Clinic
Practice address
2729 S Highway 65 82 Ste a
Lake Village, AR 71653-6136
Phone
(870) 265-5343
NPI assigned
Dec 19, 2025
Last updated
Dec 23, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CHICOT MEMORIAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 23, 2025

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

Authorized official

Name
Vicki J Allen
Title
Chief Financial Officer
Phone
(870) 265-9229

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2729 S Highway 65 82 Ste a
Lake Village, AR 71653-6136

Mailing address

2729 S Highway 65 82
Lake Village, AR 71653-6136
Phone (870) 265-9200

Other names 1

  • Lake Village Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260519001368 AR Part A Provider - Rural Health Clinic 2466576194 Practice locations: Lake Village, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821953092. Details of each certification follow.

Rural health clinic certification: CCN 048564

Legal name
CHICOT MEMORIAL MEDICAL CENTER
Doing business as
LAKE VILLAGE CLINIC
Organization structure
CorporationNon-profit
Enrollment address
2729 S Highway 65 82
Ste a
Lake Village, AR 71653-6136

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Chicot Mem Med Ctr5 organizations share this tax ID, including this one
Part of
Chicot Mem Med Ctr

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John Heard Individual Corporate OfficerPresident Feb 10, 2020
W-2 Managing EmployeeChief Executive Officer Feb 10, 2020
Shirley a Catalani Individual Corporate Officer Apr 30, 2020
Corporate Director Apr 30, 2020
Guy Dino Sabbatini Individual Corporate Director Dec 20, 2022
Vicki Allen Individual Corporate OfficerTreasurer Mar 28, 2023
W-2 Managing EmployeeChief Financial Officer Mar 28, 2023
Linda Thomas Individual Corporate Director Jun 30, 2013
Bill Elliott Individual Corporate Officer Dec 1, 2022
Corporate Director Sep 20, 2017
Carrie H Pieroni Individual Corporate Director Sep 19, 2023
Sam Angel Individual Corporate Officer Feb 1, 2014
Corporate Director May 1, 2010
John P Burge Individual Corporate Director May 1, 2010

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Change-of-ownership history 1

DateEventCounterparty
Mar 22, 2026 Change of OwnershipThis provider was the buyer Lake Village Clinic PACCN 043838, AR, NPI 1306801212

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1766102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766448000000",
    "number": "1821953092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2729 S HIGHWAY 65 82",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716536136",
            "telephone_number": "870-265-9200",
            "fax_number": "870-265-2091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2729 S HIGHWAY 65 82 STE A",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716536136",
            "telephone_number": "870-265-5343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICOT MEMORIAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHICOT MEMORIAL MEDICAL CENTER",
        "enumeration_date": "2025-12-19",
        "last_updated": "2025-12-23",
        "certification_date": "2025-12-23",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "870-265-9229"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Village Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Village, AR

Sources for this page

Verify at the official NPI Registry.