1861423352 NPI number — LAKE POINTE PARTNERS, LTD.

Table of content: (NPI 1861423352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861423352 NPI number — LAKE POINTE PARTNERS, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE POINTE PARTNERS, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAKE POINTE MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861423352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 849790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-9790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-413-6557
Provider Business Mailing Address Fax Number:
972-412-3276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6800 SCENIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROWLETT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75088-4552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-412-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMIN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VP OF GOVT PROGRAMS, TENET
Authorized Official Telephone Number:
818-436-2267

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  000625 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000404 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020966001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022534401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0803 . This is a "BCBS OF TEXAS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 450742B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 518676760 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010440-0001 . This is a "PACIFICARE OF TEXAS" identifier . This identifiers is of the category "OTHER".




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