North Lakeside Medical Clinic LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

NORTH LAKESIDE MEDICAL CLINIC LLC

Practice address

1718 N Martin Luther King Hwy
Lake Charles, LA 70601-1351

Phone

(337) 433-6500

NPI assigned

Jun 29, 2021

Organization subpart

No

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

Authorized official

Name

Frank Gray III

Title

Director

Phone

(844) 212-5321

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627430400000",
    "number": "1427628890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1718 N MARTIN LUTHER KING HWY",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706011351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 N MARTIN LUTHER KING HWY",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706011351",
            "telephone_number": "337-433-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH LAKESIDE MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-29",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "844-212-5321",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physiological Laboratory in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Physiological Laboratory in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; 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.