1285879940 NPI number — LAKEPOINTE SCC LLC

Table of content: (NPI 1285879940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285879940 NPI number — LAKEPOINTE SCC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEPOINTE SCC LLC
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:
6
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:
1285879940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 N PEARL ST STE 1050
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:
75201-7495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-252-7600
Provider Business Mailing Address Fax Number:
214-252-7704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6700 HERITAGE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKWALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75087-8748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
879-412-4000
Provider Business Practice Location Address Fax Number:
972-412-8366
Provider Enumeration Date:
12/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BEAL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
214-252-7600

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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: 001016955 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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