NPIMap

Organization Active NPI

Lakeside Medical Associates, P. a.

  • Family Medicine Physician
  • The Colony, TX
National Provider Identifier
1184846776
Registry record updated Jan 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
F2507 Issued in TX
Legal business name
LAKESIDE MEDICAL ASSOCIATES, P. A.
Practice address
6053 Main St
Suite 130
The Colony, TX 75056-4706
Phone
(972) 625-7000
Fax
(972) 625-8787
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2017

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

Authorized official

Name
Gary Vollenweider
Title
President
Phone
(972) 625-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X F2507 TX Primary

Addresses

Primary practice location

6053 Main St
Suite 130
The Colony, TX 75056-4706

Mailing address

6053 Main St
Suite 130
The Colony, TX 75056-4706
Phone (972) 625-7000

National Provider Directory

National Provider Directory

Locations

6053 Main St
Ste 130
The Colony, TX 75056
Phone (972) 625-7000

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484870400000",
    "number": "1184846776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6053 MAIN ST",
            "address_2": "SUITE 130",
            "city": "THE COLONY",
            "state": "TX",
            "postal_code": "750564706",
            "telephone_number": "972-625-7000",
            "fax_number": "972-625-8787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6053 MAIN ST",
            "address_2": "SUITE 130",
            "city": "THE COLONY",
            "state": "TX",
            "postal_code": "750564706",
            "telephone_number": "972-625-7000",
            "fax_number": "972-625-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL ASSOCIATES, P. A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2017-01-20",
        "status": "A",
        "authorized_official_last_name": "VOLLENWEIDER",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-625-7000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "F2507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in The Colony, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; 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.