NPIMap

Organization Active NPI

Lake ENT & FPS, PA

  • Specialist
  • Leesburg, FL
National Provider Identifier
1629091996
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
LAKE ENT & FPS, PA
Practice address
601 E Dixie Ave
Plaza 901
Leesburg, FL 34748-5953
Phone
(352) 728-2404
Fax
(352) 787-7401
NPI assigned
Jul 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Authorized official

Name
Judith C Milstead, M.D.NPI 1124028618
Title
President
Phone
(352) 728-2404

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

601 E Dixie Ave
Plaza 901
Leesburg, FL 34748-5953

Mailing address

601 E Dixie Ave
Plaza 901
Leesburg, FL 34748-5953
Phone (352) 728-2404

Other names 1

  • Lake Ear, Nose Throat and Facial Plastic Surgery Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061206000421 FL Part B Supplier - Clinic/Group Practice 1759380447 Receives reassigned benefits from 13 practitioners
Practice locations: Leesburg, FL; Tavares, FL; The Villages, FL

National Provider Directory

National Provider Directory

Locations

1819 Salk Ave
Tavares, FL 32778
Phone (352) 343-7279

1501 N US Highway 441
Ste 1002
The Villages, FL 32159
Phone (352) 259-4460

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601596800000",
    "number": "1629091996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E DIXIE AVE",
            "address_2": "PLAZA 901",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485953",
            "telephone_number": "352-728-2404",
            "fax_number": "352-787-7401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E DIXIE AVE",
            "address_2": "PLAZA 901",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485953",
            "telephone_number": "352-728-2404",
            "fax_number": "352-787-7401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE ENT & FPS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A",
        "authorized_official_last_name": "MILSTEAD",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-728-2404",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Ear, Nose Throat and Facial Plastic Surgery Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leesburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.