LAKESIDE CLINIC LLC NPI 1477657823

NPI Information

NPI: 1477657823
Provider Name: LAKESIDE CLINIC LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 01D0303723

Address:
2337 HOMER CLAYTON DRIVE
GUNTERSVILLE, AL
ZIP 35976
Phone: (256) 582-5131
Get Directions

LAKESIDE CLINIC LLC is a family medicine in Guntersville, AL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. LAKESIDE CLINIC LLC NPI is 1477657823. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2337 HOMER CLAYTON DRIVE
GUNTERSVILLE, AL
ZIP 35976
Phone: (256) 582-5131
Fax: (256) 582-1100

The provider's authorized official is Carolyn H Mason .
The authorized official title is Administrator and has the following contact phone number (256) 582-5131.

The CLIA number assigned to this NPI record is 01D0303723 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/7/2006 and was last updated on 4/24/2024.

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
1	207Q00000X	Family Medicine				Yes

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 Issuer
1	23185	OTHER	REED-JOHNSON AL LIC NUMB
2	051550006	OTHER	BOGGESS PROVIDER NUMBER
3	051509352	OTHER	REED-JOHNSON PROVIDER NUM
4	051518706	OTHER	FOLEY PROVIDER NUMBER
5	22839	OTHER	NIXON AL LIC NUMBER
6	9801	OTHER	BOGGESS AL LIC NUMBER
7	051502549	OTHER	NIXON PROVIDER NUMBER
8	10014	OTHER	LARSON AL LIC NUMBER
9	051550004	OTHER	LARSON PROVIDER NUMBER
10	25574	OTHER	FOLEY AL LIC NUMBER

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: 4/28/2024

NPI Synchronization or Removal

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