1952707598 NPI number — LAKESIDE EDUCATIONAL SEMINARS AND SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952707598 NPI number — LAKESIDE EDUCATIONAL SEMINARS AND SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKESIDE EDUCATIONAL SEMINARS AND SERVICES
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:
Provider Other Organization Name Type Code:
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:
1952707598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 3RD AVE S
Provider Second Line Business Mailing Address:
UNIT 411
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35502-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-471-5388
Provider Business Mailing Address Fax Number:
205-208-1709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 HIGHWAY 78 E
Provider Second Line Business Practice Location Address:
DR MALONEY NEXT TO SENIOR CARE
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35501-8907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-471-5388
Provider Business Practice Location Address Fax Number:
205-208-1709
Provider Enumeration Date:
11/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MALONEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-471-5388

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2349C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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