Lakeside Family Care Clinic

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

J6020 Issued in TX

Legal business name

LAKESIDE FAMILY CARE CLINIC

Practice address

900 Whitehead Dr.
Granbury, TX 76048

Phone

(817) 573-8320

Fax

(817) 573-8294

NPI assigned

Feb 27, 2008

Organization subpart

No

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

Authorized official

Name

Judith Abigail Moss, D.O.

Title

Doctor

Phone

(817) 573-8320

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204070400000",
    "number": "1700055423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2249",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760487249",
            "telephone_number": "817-573-8320",
            "fax_number": "817-573-8294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 WHITEHEAD DR.",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "76048",
            "telephone_number": "817-573-8320",
            "fax_number": "817-573-8294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE FAMILY CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-27",
        "last_updated": "2008-02-27",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "ABIGAIL",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "817-573-8320",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "TX",
            "license": "J6020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Granbury HB Medical Services LLC
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• Lake Pointe Resource Center, Inc.
• Lakeshore ENT
• Lakeview Dental, LLC
• Matthew Edward Lambert, PH.D.
• Megan Ann Landress, LCDC
• Donald Henry Lane, PH.D.
• Addison Langston

• Preferred Provider Organization in Granbury, TX
• Providers in Granbury, TX by specialty
• Preferred Provider Organization in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.