Lakeside Medical Pllc

LBN: Lakeside Medical Pllc
Lakeside Medical Pllc is an health care organization with primary practice located at 300 W White Mountain Blvd #C , Lakeside AZ 85929-7014. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Lakeside Medical Pllc can be contacted via phone (928) 367-6828, or through Crawford, Gaylon E via phone (928) 367-6828.

Contact Information

Primary practice address
300 W White Mountain Blvd #C Lakeside AZ 85929-7014
Phone: (928) 367-6828
Fax: (928) 367-4037
Website:
Map and Directions
Authorized official contact:
Name: Crawford, Gaylon E Doctor of Osteopathy (DO)
Phone: (928) 367-6828

Health care specialties

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

Profile Details

NPI number 1376210500
LBN Legal business name Lakeside Medical Pllc
DBA Doing business as
Authorized official Crawford, Gaylon E Doctor of Osteopathy (DO)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 25th, 2021
Last updated Mar 16th, 2022 - about 2 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 1376210500 NPPES
Arizona MEDICAID 368333

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