Organization Active NPI

Lakes Region Surgical Associates, PC

  • Surgery Physician
  • Gilford, NH
National Provider Identifier
1033289269
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
LAKES REGION SURGICAL ASSOCIATES, PC
Practice address
25 Country Club Rd
Village West, Building 7
Gilford, NH 03249-6972
Phone
(603) 528-1547
Fax
(603) 524-5536
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicola Shafique
Title
Office Manager
Phone
(603) 528-1547

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X NH Primary

Addresses

Primary practice location

25 Country Club Rd
Village West, Building 7
Gilford, NH 03249-6972

Mailing address

PO Box 1328
Auburn, ME 04211-1328
Phone (207) 784-9185

Other identifiers 1

IdentifierTypeStateIssuer
30009820MedicaidNH

National Provider Directory

National Provider Directory

Locations

25 Country Club Rd
Bldg 7
Gilford, NH 03249
Phone (603) 528-1547

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1033289269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1328",
            "city": "AUBURN",
            "state": "ME",
            "postal_code": "042111328",
            "telephone_number": "207-784-9185",
            "fax_number": "207-784-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 COUNTRY CLUB RD",
            "address_2": "VILLAGE WEST, BUILDING 7",
            "city": "GILFORD",
            "state": "NH",
            "postal_code": "032496972",
            "telephone_number": "603-528-1547",
            "fax_number": "603-524-5536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES REGION SURGICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SHAFIQUE",
        "authorized_official_first_name": "NICOLA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "603-528-1547"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "NH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30009820",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilford, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.