Organization · Type 2 NPI

Chicot Memorial Medical Center

Dental Clinic/Center · Lake Village, AR

NPI number 1861901985 Active

Practice location

2729 S. Hwy 65 82
Lake Village, AR 71653

Call (870) 265-5351 Map

Mailing address

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

Specialties and licenses

Taxonomy	Code	License
Dental Clinic/Center Primary	261QD0000X	None listed

Dental Clinic/Center: Definition to come...

Another provider at this address

Tracy Johnson, PTAPhysical Therapy Assistant Lake Village, AR NPI 1245067982

NPI record

NPI: 1861901985
Entity type: Organization (Type 2)
Issued: Sep 20, 2017
Last updated: Jun 16, 2018
Status: Active
Subpart: Yes of Chicot Memorial Medical Center

Other names

<unavail>
Chicot Memorial Medical Center Dental Clinic · other name

Authorized official

Susan Vaughn
CFO
(870) 265-9229

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1861901985

Chicot Memorial Medical Center's National Provider Identifier is 1861901985, issued on Sep 20, 2017. The primary taxonomy on file is Dental Clinic/Center (261QD0000X), and the practice location is in Lake Village, AR. The record was last updated on Jun 16, 2018.