Lakeshore Pediatrics of Russellville

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2006323 Issued in AL

Legal business name

LAKESHORE PEDIATRICS OF RUSSELLVILLE

Practice address

603 Gandy St NE
Russellville, AL 35653-1911

Phone

(256) 331-5055

Fax

(256) 383-7293

NPI assigned

Nov 29, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Agustin Rivas, M.D.

Title

Owner

Phone

(256) 386-4151

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196294400000",
    "number": "1194907394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S JACKSON HWY",
            "address_2": "SUITE 304",
            "city": "SHEFFIELD",
            "state": "AL",
            "postal_code": "356605777",
            "telephone_number": "256-386-4151",
            "fax_number": "256-383-7293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 GANDY ST NE",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356531911",
            "telephone_number": "256-331-5055",
            "fax_number": "256-383-7293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE PEDIATRICS OF RUSSELLVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-29",
        "last_updated": "2007-11-29",
        "status": "A",
        "authorized_official_last_name": "RIVAS",
        "authorized_official_first_name": "AGUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-386-4151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "2006323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Gerard Kelly
• Jody Kiel, PHARMD
• Haley Shaleigh Knight
• Harry Willi Kuberg, M.D.
• Laboratory Corporation of America Holding
• Lakeshore Pediatrics of Russellville, PC
• Mary Kathleen Laky, PHARM.D
• Jeremy Heath Lane, PHARMD
• Jimmy Gregory Lane
• Aaron Anson Legall, PT, DPT

• Pediatrics Physician in Russellville, AL
• Providers in Russellville, AL by specialty
• Pediatrics Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2007; 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.