Lakeside Medical Wellness Clinic

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

Legal business name

LAKESIDE MEDICAL WELLNESS CLINIC

Practice address

110 E Darbonne St Ste B
Sulphur, LA 70663-4958

Phone

(337) 527-9529

Fax

(337) 527-5049

NPI assigned

Jan 16, 2008

Organization subpart

No

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

Authorized official

Name

George E Smith, MD

Title

Owner

Phone

(337) 527-9529

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1235315516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E DARBONNE ST STE B",
            "city": "SULPHUR",
            "state": "LA",
            "postal_code": "706634958",
            "telephone_number": "337-527-9529",
            "fax_number": "337-527-5049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E DARBONNE ST STE B",
            "city": "SULPHUR",
            "state": "LA",
            "postal_code": "706634958",
            "telephone_number": "337-527-9529",
            "fax_number": "337-527-5049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-16",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-527-9529",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Averett Klumpp, APRN
• Koni B. Bridges, LCSW LLC
• Caitlyn Marie Kudrecki, PLPC
• Christine Kudrecki, LCSW
• Lake Area Dentistry-Carlyss
• Lakeside Medical Wellness Clinic
• Paul Gregory Lancon, DC
• Terry Alan Lane, LCSW
• Lannan Family Practice, LLC
• Maureen Rose Lannan, M.D.

• Preferred Provider Organization in Sulphur, LA
• Providers in Sulphur, LA by specialty
• Preferred Provider Organization in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.