NPIMap

Organization Active NPI

Lakeland Medical Practices

  • Otolaryngology Physician
  • Saint Joseph, MI
National Provider Identifier
1588069314
Registry record updated Mar 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
4301070920 Issued in MI
Legal business name
LAKELAND MEDICAL PRACTICES
Practice address
2680 S Cleveland Ave
Saint Joseph, MI 49085-3002
Phone
(269) 982-3368
Fax
(269) 983-3238
NPI assigned
Oct 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2016

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

Authorized official

Name
Warren White Jr.
Title
Vice President Physician Practices
Phone
(269) 983-8127

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X 4301070920 MI Primary

Addresses

Primary practice location

2680 S Cleveland Ave
Saint Joseph, MI 49085-3002

Mailing address

2680 S Cleveland Ave
Saint Joseph, MI 49085-3002
Phone (269) 982-3368

Other identifiers 1

IdentifierTypeStateIssuer
1538397120MedicaidMI

Other names 1

  • Lakeland Ear Nose & Throat Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lakeland Medical Practices49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

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

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457913600000",
    "number": "1588069314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 S CLEVELAND AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853002",
            "telephone_number": "269-982-3368",
            "fax_number": "269-983-3238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 S CLEVELAND AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853002",
            "telephone_number": "269-982-3368",
            "fax_number": "269-983-3238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND MEDICAL PRACTICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-22",
        "last_updated": "2016-03-14",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "WARREN",
        "authorized_official_title_or_position": "VICE PRESIDENT PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "269-983-8127",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "MI",
            "license": "4301070920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538397120",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeland Ear Nose & Throat",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Joseph, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; 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.