LAKESIDE CLINIC LLC NPI 1992162879

NPI Information

  • NPI: 1992162879
  • Provider Name: LAKESIDE CLINIC, LLC
  • Classification: Clinic/Center - 261QM2800X
  • Specialization: Methadone
  • Entity Type: Organization
  • Doing Business As: MEDMARK TREATMENT CENTERS CLEARWATER
  • CLIA Number: 10D2254086
  • Address: 13700 58TH ST N
    BUILDING 2, SUITE 201
    CLEARWATER, FL
    ZIP 33760
  • Phone: (727) 223-3545

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NPI Details

LAKESIDE CLINIC, LLC is a methadone clinic center in Clearwater, FL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. LAKESIDE CLINIC, LLC NPI is 1992162879. The provider is registered as an organization entity type.
The provider Is Doing Business As Medmark Treatment Centers Clearwater.

The provider's business location address is:

13700 58TH ST N
BUILDING 2, SUITE 201
CLEARWATER, FL
ZIP 33760-757
Phone: (727) 223-3545

The provider's authorized official is Bruce Jarvie .
The authorized official title is Vp, Treasurer and has the following contact phone number (214) 379-3300.

The CLIA number assigned to this NPI record is 10D2254086 - other - narcotic treatment progra with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/22/2016 and was last updated on 7/29/2024.

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
1251S00000XCommunity/Behavioral HealthNo
2261QM2800XClinic/CenterMethadoneYes
3261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo

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: 11/21/2025

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