LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC (NPI# 1003975087) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003975087 |
| Entity Type | Organization |
| Organization Name | LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC |
| Practice Address |
980 W Ironwood Dr Ste 302 Coeur D'alene ID 83814-2601 |
| Practice Telephone | 2082925437 |
| Practice Fax Number | 2082925441 |
| Mailing Telephone | 2082925437 |
| Mailing Fax Number | 2082925441 |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2012-07-12 |
| Authorized Official Name | DIANA R VANHOOK (OFFICE MANAGER) |
| Authorized Official Telephone | 2082925437 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 806408200 | 05 | |
| ID | REGENCE BLUE SHIELD GROUP | 4010138351 | 01 |
| Street Address |
980 W IRONWOOD DR STE 302 |
| City | COEUR D'ALENE |
| State | ID |
| Zip Code | 83814-2601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162675 | Dehra Mcfaddan | Social Worker | 211 E. Coeur D'alene Ave, 102, Coeur D Alene, ID 83814 | 2020-07-24 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1295353217 | Cultivation, LLC | Counselor | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, ID 83814 | 2020-07-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1730740465 | Connor Williams | Physical Therapist | 1812 W Lakewood Dr, Ste. 100, Coeur D Alene, ID 83814 | 2019-06-24 |
| 1912480153 | Nadine M Lewis | Social Worker | 211 E. Coeur D'alene Ave., Coeur D'alene, ID 83814 | 2018-09-13 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1346758042 | Heather Marie Johnson | Counselor | 7905 Meadowlark Way, Cda, ID 83814 | 2018-01-16 |
| 1881113413 | Brevity Treatment Services | Counselor | 2201 N. Government Way Ste. L, Coeur D'alene, ID 83814 | 2017-09-14 |
| 1366969628 | Jennifer La Gina Highfield | Massage Therapist | 1104 N Ste B, Coeur D Alene, ID 83814 | 2017-08-28 |
| Find all providers in zip 83814 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285797241 | Roger W. Boe | Pediatrics | 405 W Whitman St, Pocatello, ID 83204-3317 | 2006-12-19 |
| 1184738700 | Christian Carter Yost | Pediatrics | 950 Hospital Way Ste A, Pocatello, ID 83201-2762 | 2006-08-19 |
| 1437151446 | Matthew Ayers Murdoch | Pediatrics | 1151 Hospital Way, Building F, Pocatello, ID 83201-5091 | 2005-08-10 |
| 1053675629 | Kootenai Kids Pediatrics Pllc | Pediatrics | 761 N Thornton St, Ste A, Post Falls, ID 83854-6105 | 2012-06-28 |
| 1255621793 | Mitchael Conrad Steorts | Pediatrics | 2375 Coronado St, Idaho Falls, ID 83404-7407 | 2011-04-18 |
| 1912223959 | Cindy Elizabeth Parsons | Pediatrics | 1151 Hospital Way, Bldg F, Pocatello, ID 83201 | 2010-04-15 |
| 1861681611 | Steven Alan Smith | Pediatrics | 6348 W Emerald St, Boise, ID 83704-8732 | 2007-10-17 |
| 1366560971 | Idaho Falls Pediatrics | Pediatrics | 2375 Coronado St, Idaho Falls, ID 83404-7407 | 2007-03-26 |
| 1962516583 | Gentry C Yost | Pediatrics | 1151 Hospital Way, Building F, Pocatello, ID 83201-5091 | 2006-08-19 |
| 1114954179 | Sandpoint Pediatrics LLP | Pediatrics | 420 N 2nd Ave, 100, Sandpoint, ID 83864-1552 | 2006-06-27 |
| Find all providers with the same taxonomy | ||||
| City | COEUR D'ALENE |
| Zip Code | 83814 |
Please comment or provide details below to improve the information on LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.