1699004259 NPI number — LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.

Table of content: (NPI 1699004259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699004259 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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
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NPI Number Information

NPI Number:
1699004259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7527 ULMERTON ROAD
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-535-7250
Provider Business Mailing Address Fax Number:
727-535-5272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5406 HOOVER BLVD
Provider Second Line Business Practice Location Address:
SUITE 21
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33634-5330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-248-8149
Provider Business Practice Location Address Fax Number:
813-884-7085
Provider Enumeration Date:
12/10/2009

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:
727-532-7644

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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