MEDICARE: OAK PARK MEDICAL C,LINIC, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C-4126	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57250	OTHER	AR	BLUE CROSS

General Provider Information

NPI Number	:	1902865579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK PARK MEDICAL C,LINIC, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 2335
Second Line	:
City	:	BATESVILLE
State	:	AR
Zip	:	72503-2335
Country	:	US
Telephone Number	:	870-793-6887
Fax Number	:	870-793-8085

Provider Business Practice Location Address
First Line	:	1301 WHITE DR
Second Line	:
City	:	BATESVILLE
State	:	AR
Zip	:	72501-9467
Country	:	US
Telephone Number	:	870-793-6887
Fax Number	:	870-793-8085

Authorized Official
Title or Position	:	CEO
Name	:	DR. LACKEY GENE MOODY
Credential	:	M.D.
Telephone Number	:	870-793-9887

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1770570491 — JACKSON PHARMACY INC
Practice Location Address:

1305 WHITE DR
BATESVILLE, AR
72501-9467

Practice Phone: 870-698-1974
Practice Fax: 870-698-0141

1730149741 — DR. LACKEY GENE MOODY M.D.
Practice Location Address:

1301 WHITE DR
BATESVILLE, AR
72501-9467

Practice Phone: 870-793-6887
Practice Fax: 870-793-8085

1477637841 — LONNIE EVERRETT JACKSON III P.D.
Practice Location Address:

1305 WHITE DR
BATESVILLE, AR
72501-9467

Practice Phone: 870-698-1974
Practice Fax: 870-698-0141

1770709321 — WHITE RIVER CHIROPRACTIC LIFE CENTER, INC.
Practice Location Address:

1361 WHITE DR
BATESVILLE, AR
72501-9467

Practice Phone: 870-698-1650
Practice Fax: 870-793-4790

1881886893 — J. DUSTIN TAYLOR D.C.
Practice Location Address:

1361 WHITE DR
BATESVILLE, AR
72501-9467

Practice Phone: 870-698-1650
Practice Fax:

1184015422 — MRS. ERIN SANDEFUR APRN
Practice Location Address:

1301 WHITE DR
BATESVILLE, AR
72501-9467

Practice Phone: 870-793-5504
Practice Fax: 870-262-3253

Directions to “OAK PARK MEDICAL C,LINIC, P.A. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.