Lake Park Surgicare, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

261QA1903X Issued in IN

Legal business name

LAKE PARK SURGICARE, LLC

Practice address

7921 Grand Blvd
Hobart, IN 46342-6663

Phone

(219) 942-9600

Fax

(219) 947-9922

NPI assigned

Oct 5, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Rebecca Maksimovich

Title

Clinical Coordinator

Phone

(219) 942-9600

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073500930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7921 GRAND BLVD",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426663",
            "telephone_number": "219-942-9600",
            "fax_number": "219-947-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7921 GRAND BLVD",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426663",
            "telephone_number": "219-942-9600",
            "fax_number": "219-947-9922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PARK SURGICARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAKSIMOVICH",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CLINICAL COORDINATOR",
        "authorized_official_telephone_number": "219-942-9600",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "261QA1903X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000191299",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fadee Kutom, MD
• Labcorp Indiana Inc
• Laboratory Corporation of America Holdings
• Lake Park Clinic, P.C.
• Lake Park Dental Group
• Lakeshore Anesthesia, P.C.
• Mariah Landeros, RBT
• Mary Latham
• Lauren W. Harting MD
• Lavendura LLC

• Ambulatory Surgical Clinic/Center in Hobart, IN
• Providers in Hobart, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.