Lakeside Family Practice Pllc

LBN: Lakeside Family Practice Pllc
Lakeside Family Practice Pllc is an health care organization with primary practice located at 933 Cheat Rd , Morgantown WV 26508-5631. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Lakeside Family Practice Pllc can be contacted via phone (304) 594-2400, or through Hawthorne, Brian W via phone (304) 594-2400.

Contact Information

Primary practice address
933 Cheat Rd Morgantown WV 26508-5631
Phone: (304) 594-2400
Fax: (304) 594-2256
Website:
Map and Directions
Authorized official contact:
Name: Hawthorne, Brian W Doctor of Medicine (MD)
Phone: (304) 594-2400

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X

Profile Details

NPI number 1205919917
LBN Legal business name Lakeside Family Practice Pllc
DBA Doing business as
Authorized official Hawthorne, Brian W Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 24th, 2006
Last updated May 9th, 2011 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205919917 NPPES
West Virginia Other 001709238 BLUE SHIELD GROUP PROVIDE
West Virginia MEDICAID 3810002243 BLUE SHIELD GROUP PROVIDE

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