NPIMap

Organization Active NPI

Lakeshore Pediatrics P.C.

  • Pediatrics Physician
  • Sheffield, AL
National Provider Identifier
1447358619
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
17108 Issued in AL
Legal business name
LAKESHORE PEDIATRICS P.C.
Doing business as
Lakeshore Pediatrics P.C.
Practice address
1120 S Jackson Hwy
Suite 304
Sheffield, AL 35660-5777
Phone
(256) 386-4151
Fax
(256) 383-7293
NPI assigned
Sep 20, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Agustin Rivas, M.D.
Title
President
Phone
(256) 386-4151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 17108 AL Primary

Addresses

Primary practice location

1120 S Jackson Hwy
Suite 304
Sheffield, AL 35660-5777

Mailing address

1120 S Jackson Hwy
Suite 304
Sheffield, AL 35660-5777
Phone (256) 386-4151

Other names 1

  • Lakeshore Pediatrics P.C. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lakeshore Pediatrics PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1120 S Jackson Hwy
Ste 304
Sheffield, AL 35660
Phone (256) 386-4151

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1447358619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S JACKSON HWY",
            "address_2": "SUITE 304",
            "city": "SHEFFIELD",
            "state": "AL",
            "postal_code": "356605777",
            "telephone_number": "256-386-4151",
            "fax_number": "256-383-7293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S JACKSON HWY",
            "address_2": "SUITE 304",
            "city": "SHEFFIELD",
            "state": "AL",
            "postal_code": "356605777",
            "telephone_number": "256-386-4151",
            "fax_number": "256-383-7293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE PEDIATRICS P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "RIVAS",
        "authorized_official_first_name": "AGUSTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-386-4151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "17108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeshore Pediatrics P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sheffield, AL

Sources for this page

  • 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.