LAKE SHORE CLINIC (NPI# 1366566424) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366566424 |
| Entity Type | Organization |
| Organization Name | LAKE SHORE CLINIC |
| Practice Address |
921 N Lake Shore Dr Culver IN 46511-1207 |
| Practice Telephone | 5748424330 |
| Mailing Telephone | 5748424330 |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2018-06-21 |
| Authorized Official Name | JUDITH A DEERY (BUSINESS MANAGER) |
| Authorized Official Telephone | 5748423327 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 207Q000000X | IN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | TAXONOMY | 207Q000000X | 01 |
| IN | CLIA NUMBER | 15D0356500 | 01 |
| Street Address |
921 N LAKE SHORE DR |
| City | CULVER |
| State | IN |
| Zip Code | 46511-1207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306814413 | Michael F Deery | Family Medicine | 921 N Lake Shore Dr, Culver, IN 46511 | 2006-03-14 |
| 1730274556 | Noemi Adame | Pediatrics | 921 N Lake Shore Dr, Culver, IN 46511-1207 | 2006-10-04 |
| 1235245002 | Rebecca M Brice | Family Medicine | 921 N Lake Shore Dr, Culver, IN 46511-1207 | 2006-08-22 |
| 1225083371 | Melissa M Ilg | Family Medicine | 921 N Lake Shore Dr, Culver, IN 46511-1207 | 2006-05-24 |
| 1467404640 | Warren K Reiss | Family Medicine | 921 N Lake Shore Dr, Culver, IN 46511-1207 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437309838 | Kristine Marie Weaver | Nurse Practitioner | 232 S Main St Ste A, Culver, IN 46511 | 2008-09-23 |
| 1649361031 | John R. Bernero | Internal Medicine | 1680 E. Shore Dr., Culver, IN 46511 | 2006-09-28 |
| 1427595842 | Mackenzie Davenport | Specialist/Technologist | 1300 Academy Rd, Culver, IN 46511 | 2017-01-24 |
| 1033624499 | Stephanie Stichter | Specialist/Technologist | 701 School St, Culver, IN 46511-1026 | 2017-12-07 |
| 1104155415 | Culver Community Schools | Local Education Agency (LEA) | 700 School St, Culver, IN 46511-1027 | 2009-12-15 |
| 1770504813 | Johnson Memorial Hospital | Durable Medical Equipment & Medical Supplies | 730 School St, Culver, IN 46511-1027 | 2006-07-22 |
| 1679970644 | Culver Comm Sch Corp | Point of Service | 700 School St, Culver, IN 46511-1027 | 2014-11-19 |
| 1184672032 | Kurt Nathan Richeson | Dentist | 1001 N Lake Shore Dr, Culver, IN 46511-1209 | 2006-05-04 |
| 1891037164 | Ourhealth Physician Group, LLC | Clinic/Center | 121 N Terrace Dr, Culver, IN 46511-1222 | 2013-03-25 |
| 1982199014 | Brian Rosenau | Specialist/Technologist | 1300 Academy Rd # 95, Culver, IN 46511-1234 | 2018-07-01 |
| Find all providers in zip 46511 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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| 1063021129 | Affordable Lab Solutions | Clinic/Center | 1121 16th St, Bedford, IN 47421-3721 | 2020-07-24 |
| 1568071710 | Ivx Health of Indiana PC | Clinic/Center | 9510 N Meridian St Ste D, Indianapolis, IN 46260-1333 | 2020-07-23 |
| 1346867942 | Henry County Memorial Hospital | Clinic/Center | 4760 National Rd W, Richmond, IN 47374-4745 | 2020-06-30 |
| 1114541935 | Ourhealth Physicians Group, LLC | Clinic/Center | 9998 N Michigan Rd, Carmel, IN 46032-9640 | 2020-06-08 |
| 1366076564 | Sullivan County Community Hospital | Clinic/Center | 4146 S 7th St Ste B, Terre Haute, IN 47802-4123 | 2020-02-26 |
| 1497306310 | Activate Healthcare - Ibew Local 153/ua Local 172 South Bend | Clinic/Center | 3371 W Cleveland Road Ext Ste 120, South Bend, IN 46628-9780 | 2019-09-23 |
| 1437707601 | Nuyou Therapies, LLC | Clinic/Center | 5401 Vogel Rd Ste 740, Evansville, IN 47715-7834 | 2019-08-29 |
| 1306492160 | Deaconess Clinic, Inc. | Clinic/Center | 315 N 1st Ave, Evansville, IN 47710-1218 | 2019-08-16 |
| 1750941902 | Unity Healthcare LLC | Clinic/Center | 1345 Unity Pl Ste 220, Lafayette, IN 47905-5761 | 2019-06-19 |
| Find all providers with the same taxonomy | ||||
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| 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.