LAKESHORE PEDIATRICS OF RUSSELLVILLE, PC (NPI# 1326352873) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326352873 |
| Entity Type | Organization |
| Organization Name | LAKESHORE PEDIATRICS OF RUSSELLVILLE, PC |
| Other Organization Name | DBA LAKESHORE PEDIATRIC RURAL HEALTH CLINIC |
| Practice Address |
603 Gandy St Ne Russellville AL 35653-1911 |
| Practice Telephone | 2563315055 |
| Practice Fax Number | 2564604647 |
| Mailing Telephone | 2563315055 |
| Mailing Fax Number | 2564604647 |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2010-07-27 |
| Authorized Official Name | REBECCA THOMPSON (DIRECTOR) |
| Authorized Official Telephone | 2563315055 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
AL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| dba Lakeshore Pediatric Rural Health Clinic | Doing Business As Name - Organization |
| Street Address |
603 GANDY ST NE |
| City | RUSSELLVILLE |
| State | AL |
| Zip Code | 35653-1911 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194907394 | Lakeshore Pediatrics of Russellville | Pediatrics | 603 Gandy St Ne, Russellville, AL 35653-1911 | 2007-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902384720 | Randy Wade Gooch | Pharmacist | 13675 Us-43, Russellville, AL 35653 | 2018-08-02 |
| 1700301470 | Carole Ann Montgomery | Pharmacist | Walmart Pharmacy, 13675 Us-43, Russellville, AL 35653 | 2017-08-03 |
| 1548632755 | Amanda Carrie Franks | Health Educator | 265 Skyline Dr, Russellville, AL 35653 | 2015-10-27 |
| 1023411220 | Wesley Charles Mayfield | Pharmacist | 14001 Hwy 43 Suite 13, Russellville, AL 35653 | 2014-10-01 |
| 1831322841 | Family Health Care Clinic, Inc. | Clinic/Center | 318 Coffee Ave Ne, Russellville, AL 35653 | 2009-08-25 |
| 1538371075 | Eyedocs On Wheels PC | Optometrist | 15255 Hwy 43, Russellville, AL 35653 | 2007-05-04 |
| 1063634574 | Russellville Physician Practices LLC | Orthopaedic Surgery | 715 Gandy Street Ne, Suite B, Russellville, AL 35653 | 2007-05-03 |
| 1750404141 | Alabama Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 14695 Hwy 43, Russellville, AL 35653 | 2007-04-09 |
| 1629111703 | Franklin County Health Dept Offsite Epsdt | Public Health or Welfare | 801 Highway 48, Russellville, AL 35653 | 2007-02-15 |
| 1750457941 | Southern Rural Health Care Consortium, Inc. | Clinic/Center | 318 Coffee Avenue, Russellville, AL 35653 | 2006-11-28 |
| Find all providers in zip 35653 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669830881 | Medexpress Littleville LLC | Clinic/Center | 1369a George Wallace Hwy, Russellville, AL 35654-3281 | 2016-02-02 |
| 1548682578 | Medexpress Littleville LLC | Clinic/Center | 1369a George Wallace Hwy, Russellville, AL 35654-3281 | 2014-01-10 |
| 1902145188 | Kevin Gerard Kelly | Clinic/Center | 13150 Highway 43, Suite 10, Russellville, AL 35653-4558 | 2013-02-07 |
| 1932246659 | Logan Memorial Hospital LLC | Clinic/Center | 1625 Nashville St, Russellville, KY 42276-8853 | 2007-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982205753 | Pickens County Primary Care PC | Clinic/Center | 99 Commerce Avenue, Carrollton, AL 35447 | 2020-11-06 |
| 1952952541 | Pediatric Associates of Alexander City PC | Clinic/Center | 21 Coosa County Road 50, Kellyton, AL 35089-1900 | 2019-09-25 |
| 1205309044 | Boa Vida Hospital of Aberdeen, Ms LLC | Clinic/Center | 184 William E Hill Drive Ste C, Carrollton, AL 35447 | 2019-01-04 |
| 1487123915 | Physicians Care of Camden LLC | Clinic/Center | 24b Camden Byp, Camden, AL 36726-1770 | 2018-11-14 |
| 1336634666 | Central Pediatrics of Somerville LLC | Clinic/Center | 3609 Highway 67 S, Somerville, AL 35670 | 2018-06-28 |
| 1578060349 | Ivy Creek of Elmore, LLC | Clinic/Center | 4412 Hogan Rd, Deatsville, AL 36022-3400 | 2018-04-09 |
| 1568915106 | Physicians Care of Grove Hill LLC | Clinic/Center | 127 Clark St Ste C&d, Grove Hill, AL 36451-3050 | 2016-08-01 |
| 1205294428 | Red Bay Hospital Outpatient Clinics LLC | Clinic/Center | 14490 County Line Road, Suite A, Muscle Shoals, AL 35661 | 2016-02-02 |
| 1972985968 | Athens Limestone Pediatric Center LLC | Clinic/Center | 101 Fitness Way Ste 2100, Athens, AL 35611-2494 | 2015-06-25 |
| 1396125258 | D W Mcmillan Memorial Hospital | Clinic/Center | 1674 Cleveland Ave, Castleberry, AL 36432 | 2015-06-05 |
| Find all providers with the same taxonomy | ||||
| City | RUSSELLVILLE |
| Zip Code | 35653 |
Please comment or provide details below to improve the information on LAKESHORE PEDIATRICS OF RUSSELLVILLE, PC.
| 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.