NPIMap

Organization Active NPI

Lakeshore Anesthesia Group, PLLC

  • Certified Registered Nurse Anesthetist
  • Dallas, TX
National Provider Identifier
1689611550
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
LAKESHORE ANESTHESIA GROUP, PLLC
Practice address
9440 Poppy Dr
Dallas, TX 75218-3652
Phone
(214) 324-6100
Fax
(214) 324-6141
NPI assigned
Jun 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Mr. Richard B. Millson, CRNANPI 1730138462
Title
President
Phone
(214) 236-5643

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
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

9440 Poppy Dr
Dallas, TX 75218-3652

Mailing address

PO Box 181780
Dallas, TX 75218-8780
Phone (214) 236-5643

Other identifiers 2

IdentifierTypeStateIssuer
00C09VOtherTXBCBS
185036401MedicaidTX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1689611550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 181780",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752188780",
            "telephone_number": "214-236-5643",
            "fax_number": "214-321-9160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9440 POPPY DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752183652",
            "telephone_number": "214-324-6100",
            "fax_number": "214-324-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE ANESTHESIA GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "MILLSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-236-5643",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00C09V",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185036401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; 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.