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LAKESHORE MEDICAL CARE CENTER INC NPI 1124195573


NPI Information

NPI: 1124195573
Provider Name: LAKESHORE MEDICAL CARE CENTER, INC
Classification: Preferred Provider Organization - 305R00000X
Entity Type: Organization
Address:
4616 SAN JUAN AVE
JACKSONVILLE, FL
ZIP 32210
Phone: (904) 384-5385
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LAKESHORE MEDICAL CARE CENTER, INC is a preferred provider organization in Jacksonville, FL. The provider is a group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. LAKESHORE MEDICAL CARE CENTER, INC NPI is 1124195573. The provider is registered as an organization entity type.

The provider's business location address is:

4616 SAN JUAN AVE
JACKSONVILLE, FL
ZIP 32210-228
Phone: (904) 384-5385
Fax: (904) 388-5838

The provider's authorized official is Tracy Teagle .
The authorized official title is Office Manager and has the following contact phone number (904) 384-5385.

The enumeration date for this NPI number is 11/29/2006 and was last updated on 12/27/2010.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1305R00000XPreferred Provider OrganizationME0018387FLORIDANo
2305R00000XPreferred Provider Organization0042816FLORIDAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
126456MEDICARE ID-TYPE UNSPECIFIEDFLORIDA
216859WMEDICARE ID-TYPE UNSPECIFIEDFLORIDA

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

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