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LAKE AREA PEDIATRICS NPI 1285645911


NPI Information

NPI: 1285645911
Provider Name: LAKE AREA PEDIATRICS
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 45D2137856

Address:
18057 HWY 105 WEST
STE. 220
MONTGOMERY, TX
ZIP 77356
Phone: (936) 582-5620
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LAKE AREA PEDIATRICS is a pediatrics in Montgomery, TX. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. LAKE AREA PEDIATRICS NPI is 1285645911. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

18057 HWY 105 WEST
STE. 220
MONTGOMERY, TX
ZIP 77356
Phone: (936) 582-5620
Fax: (936) 582-5621

The provider's authorized official is Jack S Robinson .
The authorized official title is Owner and has the following contact phone number (936) 582-5620.

The CLIA number assigned to this NPI record is 45D2137856 - ancillary testing site in health care center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/10/2006 and was last updated on 1/6/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsL3800TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1A91455MEDICARE UPINTEXAS
21740276856OTHERTEXASINDIVIDUAL NPI
3158814702MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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