NPIMap

Organization Active NPI

Neurology Headache Associates, LLC

  • Neurology Physician
  • Lakeland, FL
National Provider Identifier
1104538255
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
NEUROLOGY HEADACHE ASSOCIATES, LLC
Practice address
6500 N Socrum Loop Rd Ste 200
Lakeland, FL 33809-4179
Phone
(863) 853-3331
NPI assigned
Dec 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Authorized official

Name
Eric F Stakebake, PANPI 1619215738
Title
Owner
Phone
(801) 603-8002

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

6500 N Socrum Loop Rd Ste 200
Lakeland, FL 33809-4179

Mailing address

6500 N Socrum Loop Rd Ste 200
Lakeland, FL 33809-4179
Phone (863) 853-3331

National Provider Directory

National Provider Directory

Locations

6500 N Socrum Loop Rd
#200
Lakeland, FL 33809
Phone (863) 853-3331

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": "1671494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1104538255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 N SOCRUM LOOP RD STE 200",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338094179",
            "telephone_number": "863-853-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 N SOCRUM LOOP RD STE 200",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338094179",
            "telephone_number": "863-853-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROLOGY HEADACHE ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-20",
        "last_updated": "2023-09-06",
        "certification_date": "2022-11-09",
        "status": "A",
        "authorized_official_last_name": "STAKEBAKE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-603-8002",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.