Lakeshore Medical Care Center, Inc

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

0042816 Issued in FL

Legal business name

LAKESHORE MEDICAL CARE CENTER, INC

Practice address

4616 San Juan Ave
Jacksonville, FL 32210-3228

Phone

(904) 384-5385

Fax

(904) 388-5838

NPI assigned

Nov 29, 2006

Organization subpart

No

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

Authorized official

Name

Miss Tracy Teagle

Title

Office Manager

Phone

(904) 384-5385

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293408000000",
    "number": "1124195573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4616 SAN JUAN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322103228",
            "telephone_number": "904-384-5385",
            "fax_number": "904-388-5838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4616 SAN JUAN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322103228",
            "telephone_number": "904-384-5385",
            "fax_number": "904-388-5838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE MEDICAL CARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2010-12-27",
        "status": "A",
        "authorized_official_last_name": "TEAGLE",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "904-384-5385",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "FL",
            "license": "0042816",
            "primary": true
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "FL",
            "license": "ME0018387",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Preferred Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2010; 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.