| NPI | 1548949852 |
|---|---|
| Doing Business As | OB LAKE VILLAGE |
| Entity Type | Organization |
| Authorized Contact | GARY ALLAN NICHOLS CEO 870-942-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2024-07-11 |