1639376163 NPI number — LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.

Table of content: (NPI 1639376163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639376163 NPI number — LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1639376163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7527 ULMERTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33771-4548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-586-0138
Provider Business Mailing Address Fax Number:
727-586-6954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2314 N ORANGE BLOSSOM TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32804-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-428-9233
Provider Business Practice Location Address Fax Number:
407-428-9667
Provider Enumeration Date:
06/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUZIK
Authorized Official First Name:
ARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
727-586-0138

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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