Organization Active NPI

Lakeside Neurocare

  • Neurology Physician
  • Oshkosh, WI
National Provider Identifier
1083048730
Registry record updated Aug 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
LAKESIDE NEUROCARE
Practice address
855 N Westhaven Dr
Oshkosh, WI 54904-7668
Phone
(920) 223-5580
Fax
(920) 223-3580
NPI assigned
Aug 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2013

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

Authorized official

Name
Susan M Golden, CPC
Title
Business Manager
Phone
(920) 223-5582

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X WI Primary

Addresses

Primary practice location

855 N Westhaven Dr
Oshkosh, WI 54904-7668

Mailing address

2700 W 9TH Ave Ste 225
Oshkosh, WI 54904-7865
Phone (920) 223-5580

Other identifiers 1

IdentifierTypeStateIssuer
32820600MedicaidWI

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1377734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377734400000",
    "number": "1083048730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 W 9TH AVE STE 225",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549047865",
            "telephone_number": "920-223-5580",
            "fax_number": "920-223-3580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 N WESTHAVEN DR",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549047668",
            "telephone_number": "920-223-5580",
            "fax_number": "920-223-3580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE NEUROCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-29",
        "last_updated": "2013-08-29",
        "status": "A",
        "authorized_official_last_name": "GOLDEN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "920-223-5582",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32820600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oshkosh, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2013; 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.