Active NPI
Lake Jackson Clinic, P.a.
- Family Medicine Physician
- Lake Jackson, TX
National Provider Identifier
1205830668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- E6263
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryLocations
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
- Bailey Victoria Laday
- Amy Catherine Laird-Payne, PYSICIAN ASSISTANT
- Lake Jackson Assisted Living, LTD.
- Lake Jackson Audiology and Hearing Aid Consultants, LLC
- Lake Jackson Chiropractic and Rehab PC
- Lake Jackson Dental Care P.a.
- Lake Jackson Dialysis and Kidney Center, LTD, LLP
- Lake Jackson Emergency Medical Services, Inc.
- Lake Jackson Endoscopy Center, LP.
- Lake Jackson Family Dentistry PLLC
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.