ESSENTIAL HEALTHCARE LLC NPI 1720572407

NPI Information

NPI: 1720572407
Provider Name: ESSENTIAL HEALTHCARE LLC

Doing Business As: LAKESIDE PRIMARY CARE

Classification: Nurse Practitioner - 363LP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 01D2152025

Address:
1260 CHESNUT BYPASS
SUITE A
CENTRE, AL
ZIP 35960
Phone: (256) 266-1544
Get Directions

ESSENTIAL HEALTHCARE LLC is a primary care nurse practitioner in Centre, AL. ESSENTIAL HEALTHCARE LLC NPI is 1720572407. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Lakeside Primary Care.

The provider's business location address is:

1260 CHESNUT BYPASS
SUITE A
CENTRE, AL
ZIP 35960-834
Phone: (256) 266-1544
Fax: (256) 266-1531

The provider's authorized official is Aimee Kilgo .
The authorized official title is President and has the following contact phone number (256) 266-1544.

The CLIA number assigned to this NPI record is 01D2152025 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/18/2018 and was last updated on 12/1/2020.

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	363LP2300X	Nurse Practitioner	Primary Care			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 State	Other Provider Identifier Issuer
1	224799	MEDICAID	ALABAMA

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: 11/14/2023

NPI Synchronization or Removal

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