Lakeside Surgical Associates, PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

9600335 Issued in NC

Legal business name

LAKESIDE SURGICAL ASSOCIATES, PA

Practice address

150 Fairview Rd
Suite 300
Mooresville, NC 28117-9504

Phone

(704) 664-6677

Fax

(704) 663-1009

NPI assigned

Jan 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gregory B Hall, M. D., F.A.C.S

Title

President

Phone

(704) 664-6677

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278374400000",
    "number": "1487709713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 FAIRVIEW RD",
            "address_2": "SUITE 300",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179504",
            "telephone_number": "704-664-6677",
            "fax_number": "704-663-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 FAIRVIEW RD",
            "address_2": "SUITE 300",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179504",
            "telephone_number": "704-664-6677",
            "fax_number": "704-663-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE SURGICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2010-07-06",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-664-6677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D., F.A.C.S"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "9600335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8938320",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2010; 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.