Lakebridge Medical Investors, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LAKEBRIDGE MEDICAL INVESTORS, LLC

Practice address

115 Woodlawn Dr
Johnson City, TN 37604-5978

Phone

(423) 975-0095

Fax

(423) 928-0358

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Jimmy (J.R.) R Lewis

Title

Chief Manager

Phone

(423) 975-5455

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• lakebridge health care center Doing business as

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1407933443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 WOODLAWN DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045978",
            "telephone_number": "423-975-0095",
            "fax_number": "423-928-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 WOODLAWN DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045978",
            "telephone_number": "423-975-0095",
            "fax_number": "423-928-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEBRIDGE MEDICAL INVESTORS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "JIMMY  (J.R.)",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF MANAGER",
        "authorized_official_telephone_number": "423-975-5455"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TN",
            "license": "0000000340",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445358",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440576",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "lakebridge health care center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brittany Ann Laehn, PA-C
• Madonna L Laffey, APRN
• Melanie Laforce, APRN
• Elisa J Lafountain, DO
• Lakebridge a Waters Community LLC
• Shankar Lal
• Jodie Ann Lamb, BS
• Michelle W Lamb, PT
• Mary Erney Lamoy, BA
• Jennifer Lancaster, LCSW, Q-SAP

• Skilled Nursing Facility in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; 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.