Provider Demographics
NPI:1922609833
Name:LAFAYETTE COUNTY FAMILY PRACTICE
Entity Type:Organization
Organization Name:LAFAYETTE COUNTY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:IV
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-299-0480
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71845-1028
Mailing Address - Country:US
Mailing Address - Phone:870-299-0480
Mailing Address - Fax:
Practice Address - Street 1:226 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:AR
Practice Address - Zip Code:71845
Practice Address - Country:US
Practice Address - Phone:870-299-0480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty