NPIMap

Organization Active NPI

Lakeside Medical Response

  • Ambulance
  • Lake City, SC
National Provider Identifier
1528286374
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
License
234 Issued in SC
Legal business name
LAKESIDE MEDICAL RESPONSE
Practice address
770 S Ron McNair Blvd
Unit a
Lake City, SC 29560-3824
Phone
(843) 374-7480
NPI assigned
Apr 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Shameeka S McDuffie
Title
Owner
Phone
(843) 260-0922

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X 234 SC Primary

Addresses

Primary practice location

770 S Ron McNair Blvd
Unit a
Lake City, SC 29560-3824

Mailing address

770 S Ron McNair Blvd
Unit a
Lake City, SC 29560-3824
Phone (843) 374-7480

Other identifiers 2

IdentifierTypeStateIssuer
234OtherSCDHEC
AB0255MedicaidSC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528286374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 S RON MCNAIR BLVD",
            "address_2": "UNIT A",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295603824",
            "telephone_number": "843-374-7480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 S RON MCNAIR BLVD",
            "address_2": "UNIT A",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295603824",
            "telephone_number": "843-374-7480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL RESPONSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCDUFFIE",
        "authorized_official_first_name": "SHAMEEKA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-260-0922",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "SC",
            "license": "234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHEC",
            "identifier": "234",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AB0255",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.