Provider Demographics
NPI:1578149951
Name:LANSDELL FAMILY CLINIC PLLC
Entity Type:Organization
Organization Name:LANSDELL FAMILY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LANSDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-584-1053
Mailing Address - Street 1:500 E COLLIN RAYE DR
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-8048
Mailing Address - Country:US
Mailing Address - Phone:870-584-1053
Mailing Address - Fax:870-584-2087
Practice Address - Street 1:101 W MAIN
Practice Address - Street 2:
Practice Address - City:LOCKESBURG
Practice Address - State:AR
Practice Address - Zip Code:71846-9621
Practice Address - Country:US
Practice Address - Phone:870-289-2076
Practice Address - Fax:870-289-2043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANSDELL FAMILY CLINIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health