LAKESIDE MEDICAL WELLNESS CLINIC (NPI# 1407147234) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407147234 |
| Entity Type | Organization |
| Organization Name | LAKESIDE MEDICAL WELLNESS CLINIC |
| Practice Address |
1908 Maplewood Dr Suite B Sulphur LA 70663-6000 |
| Practice Telephone | 3376255050 |
| Practice Fax Number | 3376256726 |
| Mailing Telephone | 3376255050 |
| Mailing Fax Number | 3376256726 |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |
| Authorized Official Name | STACY W KIRKUM (ADMINISTRATOR) |
| Authorized Official Telephone | 3376255050 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | MD14484R | LA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1476269 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235315516 | Lakeside Medical Wellness Clinic | Preferred Provider Organization | 110 E Darbonne St Ste B, Sulphur, LA 70663-4958 | 2008-01-16 |
| Street Address |
1908 MAPLEWOOD DR SUITE B |
| City | SULPHUR |
| State | LA |
| Zip Code | 70663-6000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952484917 | Paul Gregory Lancon | Chiropractor | 1908 Maplewood Dr, Suite A, Sulphur, LA 70663 | 2006-10-23 |
| 1104470731 | Brooke Beriram | Behavioral Analyst | 1908 Maplewood Dr, Sulphur, LA 70663-6000 | 2019-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457822751 | Imperial Calcasieu Human Services Authority | Clinic/Center | 2651 E Napoleon St, Sulphur, LA 70663 | 2018-12-12 |
| 1083134670 | Leah Lowe | Nurse Practitioner | 1019 Mathew St., Sulphur, LA 70663 | 2017-06-23 |
| 1972037166 | Collins Orthopaedics LLC | Orthopaedic Surgery | 250 S Beglis Parkway, Ste 3, Sulphur, LA 70663 | 2017-04-14 |
| 1699219238 | Charles Miah Smith | Family Medicine | 231 W Houston River Rd., Sulphur, LA 70663 | 2016-12-16 |
| 1598213357 | Fresenius Medical Care Sulphur, LLC | Clinic/Center | 1000 Beglis Pkwy, Sulphur, LA 70663 | 2016-09-21 |
| 1992129019 | Healthscripts of America-southwest Louisiana,llc | Pharmacy | 1575 Maplewood Drive, Suite A, Sulphur, LA 70663 | 2014-02-10 |
| 1679900476 | Evergreen Presbyterian Ministries, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2108 Division Street, Sulphur, LA 70663 | 2013-10-11 |
| 1295065241 | Journey Behavioral Health, LLC | Psychologist | 423 Cypress St., Sulphur, LA 70663 | 2010-01-13 |
| 1558513754 | C H Wilkinson Physician Network | Nurse Practitioner | 525 North City Service Hwy, Sulphur, LA 70663 | 2008-10-21 |
| 1689853343 | Stelly Physical &occupational Therapy | Occupational Therapist | 946 Beglis Parkway, Sulphur, LA 70663 | 2007-10-30 |
| Find all providers in zip 70663 | ||||
| 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). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215560974 | Calcasieu Cameron Hospital Service District | Clinic/Center | 703 Cypress St Ste A, Sulphur, LA 70663-5053 | 2020-02-20 |
| 1679664080 | Ardmore Institute of Health | Clinic/Center | Rr 1 Box 4001, Sulphur, OK 73086-9796 | 2006-09-28 |
| 1619221348 | Calcasieu Cameron Hospital Service District | Clinic/Center | 1200 Stelly Ln, Sulphur, LA 70663-5134 | 2012-11-02 |
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| 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.