Organization Active NPI

Lake Jackson Clinic, P.a.

  • Family Medicine Physician
  • Lake Jackson, TX
National Provider Identifier
1205830668
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E6263 Issued in TX
Legal business name
LAKE JACKSON CLINIC, P.A.
Practice address
101A Parking Way St
Lake Jackson, TX 77566-5228
Phone
(979) 297-2441
NPI assigned
Jun 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Liem P Bui, M.D.
Title
President
Phone
(979) 297-2441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X E6263 TX Primary

Addresses

Primary practice location

101A Parking Way St
Lake Jackson, TX 77566-5228

Mailing address

101A Parking Way St
Lake Jackson, TX 77566-5228

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111110000320 TX Part B Supplier - Clinic/Group Practice 4789858689 Receives reassigned benefits from 1 practitioner
Practice locations: Lake Jackson, TX

National Provider Directory

National Provider Directory

Locations

101 Parking Way St
Ste A
Lake Jackson, TX 77566
Phone (979) 297-2441

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": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205830668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101A PARKING WAY ST",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101A PARKING WAY ST",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665228",
            "telephone_number": "979-297-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE JACKSON CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUI",
        "authorized_official_first_name": "LIEM",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "979-297-2441",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "E6263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Jackson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.