LAKESIDE FAMILY CARE CLINIC (NPI# 1700055423) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700055423 |
| Entity Type | Organization |
| Organization Name | LAKESIDE FAMILY CARE CLINIC |
| Practice Address |
900 Whitehead Dr. Granbury TX 76048 |
| Mailing Address |
Po Box 2249 Granbury TX 76048-7249 |
| Practice Telephone | 8175738320 |
| Practice Fax Number | 8175738294 |
| Mailing Telephone | 8175738320 |
| Mailing Fax Number | 8175738294 |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2008-02-27 |
| Authorized Official Name | JUDITH ABIGAIL MOSS (DOCTOR) |
| Authorized Official Telephone | 8175738320 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305R00000X | Preferred Provider Organization | J6020 | TX | Managed Care Organizations |
| Street Address |
900 WHITEHEAD DR. |
| City | GRANBURY |
| State | TX |
| Zip Code | 76048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689213415 | Tena Lee Wood I | Licensed Practical Nurse | 302 S. Crites Granbury Tx. 76048, 302 S. Crites Granbury Tx. 76048, Granbury, TX 76048 | 2019-12-26 |
| 1811456593 | Laura Nicole Graham | Counselor | 2101 West Pearl Street, Granbury, TX 76048 | 2019-03-13 |
| 1477000974 | Globalrehab - Fort Worth, Lp | Rehabilitation Hospital | 805 Hill Blve, Ste 109, Granbury, TX 76048 | 2016-09-01 |
| 1780130245 | Rachel Diane Rouse | Counselor | 1903 W Pearl Street, Granbury, TX 76048 | 2016-08-25 |
| 1477946648 | Adriana Brown | Nurse Practitioner | 805 Hill Blvd., #104, Granbury, TX 76048 | 2015-03-12 |
| 1407261233 | Rogers King Coleman | General Practice | 1411 Crawford Street, Granbury, TX 76048 | 2014-07-01 |
| 1891115176 | Trinity Nursing and Rehabilitation of Granbury, Lp | Skilled Nursing Facility | 600 Reunion Court, Granbury, TX 76048 | 2014-04-24 |
| 1639507122 | Kayelen Helton | Counselor | 807 Paluxy Road, Granbury, TX 76048 | 2013-10-22 |
| 1013257799 | Pecan Valley Mhmr Region | Counselor | 2101 W. Pearl St., Granbury, TX 76048 | 2013-02-18 |
| 1114240223 | Talbot Green Mccormick Jr. | General Practice | 2306 Cologne Dr., Granbury, TX 76048 | 2010-03-03 |
| Find all providers in zip 76048 | ||||
| Taxonomy Code | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841849494 | Face To Face Healthcare Services LLC | Preferred Provider Organization | 2616 S Loop W Ste 300, Houston, TX 77054-2672 | 2019-09-06 |
| 1700438827 | Cleveland Phillips Jr. | Preferred Provider Organization | 11146 Vance Jackson Rd Apt 3801, San Antonio, TX 78230-2563 | 2019-07-09 |
| 1154983492 | Cassandra Denese Mitchell | Preferred Provider Organization | 8319 Heights Vly, Converse, TX 78109-3503 | 2019-07-08 |
| 1083187223 | Chinese Community Center, Inc. | Preferred Provider Organization | 9800 Town Park Dr, Houston, TX 77036-2316 | 2019-01-10 |
| 1013422492 | Cicero L Sadler | Preferred Provider Organization | 4001 San Jacinto St, Houston, TX 77004-4021 | 2017-12-07 |
| 1528577483 | Mary Brown-jacobs | Preferred Provider Organization | 501 Canvas Ct, Crowley, TX 76036-4338 | 2017-09-22 |
| 1962931220 | Ai Community Services LLC | Preferred Provider Organization | 6928 Shoreway Dr, Grand Prairie, TX 75054 | 2017-06-08 |
| 1649706227 | Divine Integrity Allied Healthcare Services | Preferred Provider Organization | 4738 Bedford Ave, Midland, TX 79703-4535 | 2017-05-03 |
| 1255866950 | Guardian of Angels Community Living | Preferred Provider Organization | 12703 Jones Rd, 1115, Houston, TX 77070-4676 | 2017-05-01 |
| 1356874622 | Urban Line LLC | Preferred Provider Organization | 2500 Woodland Park Dr Apt C304, Houston, TX 77077-2278 | 2017-04-04 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on LAKESIDE FAMILY CARE CLINIC.
| 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.