Oak Park Medical C,Linic, P.a.

Key facts

NPI

1902865579

Entity type

Organization (NPI type 2)

Primary specialty

Family Medicine Physician 207Q00000X

License

C-4126 (AR)

Legal business name

OAK PARK MEDICAL C,LINIC, P.A.

Practice address

1301 White Dr
Batesville, AR 72501-9467

Phone

(870) 793-6887

Fax

(870) 793-8085

NPI assigned

Mar 21, 2006

Organization subpart

No

Authorized official

Name

Dr. Lackey Gene Moody, M.D.

Title

Ceo

Phone

(870) 793-9887

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary S Anderson, MD Family Medicine Physician · Marshall, TX · NPI 1083611057
  NPD (past) FAMILY MEDICINE
• Richard Thomas Oliver Jr., PA-C Medical Physician Assistant · Spokane, WA · NPI 1699000224
  NPD (past)

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902865579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2335",
            "city": "BATESVILLE",
            "state": "AR",
            "postal_code": "725032335",
            "telephone_number": "870-793-6887",
            "fax_number": "870-793-8085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 WHITE DR",
            "city": "BATESVILLE",
            "state": "AR",
            "postal_code": "725019467",
            "telephone_number": "870-793-6887",
            "fax_number": "870-793-8085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK PARK MEDICAL C,LINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "LACKEY",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-793-9887",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C-4126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "57250",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Batesville, AR

• North Arkansas Pain Managment PA
• North Arkansas Radiology
• Northeast Arkansas Community Mental Health Center Inc Inc
• Morgan E. Norton, M.D.
• Amy Leigh O'Rourke
• Nelson A. Obikwu, MD
• Occuplaytional Therapy Services
• Odyssey Healthcare Operating a, LP
• Lisa Ohlson, LMSW
• Samson Olaitan, MD

All providers in Batesville, AR · Family Medicine Physician in Arkansas