NPIMap

Organization Active NPI

Lakeside Memorial Hospital Inc.

  • General Acute Care Hospital
  • Brockport, NY
National Provider Identifier
1730392929
Registry record updated Jul 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
LAKESIDE MEMORIAL HOSPITAL INC.
Practice address
80 West Ave
Suite 209
Brockport, NY 14420-1322
Phone
(585) 637-6044
Fax
(585) 637-6053
NPI assigned
May 7, 2007
Organization subpart
Yes
Parent organization
LAKESIDE MEMORIAL HOSPITAL INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2010

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

Authorized official

Name
Michael Stapleton
Title
Ceo
Phone
(585) 395-6095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

80 West Ave
Suite 209
Brockport, NY 14420-1322

Mailing address

80 West Ave
Suite 209
Brockport, NY 14420-1322
Phone (585) 637-6044

Other identifiers 3

IdentifierTypeStateIssuer
14005907OtherNYEXCELLUS-OUTPATIENT
00279543MedicaidNY
PC103050AXOtherNYPREFERRED CARE

Other names 1

  • Family Wellness Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Internal Medicine at Lakeside6 organizations share this tax ID, including this one
Part of
Internal Medicine at Lakeside

Other organizations with this tax ID 5

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

Locations

80 West Ave
Ste 209
Brockport, NY 14420
Phone (585) 637-6044

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279065600000",
    "number": "1730392929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 WEST AVE",
            "address_2": "SUITE 209",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201322",
            "telephone_number": "585-637-6044",
            "fax_number": "585-637-6053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 WEST AVE",
            "address_2": "SUITE 209",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201322",
            "telephone_number": "585-637-6044",
            "fax_number": "585-637-6053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEMORIAL HOSPITAL INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKESIDE MEMORIAL HOSPITAL INC.",
        "enumeration_date": "2007-05-07",
        "last_updated": "2010-07-14",
        "status": "A",
        "authorized_official_last_name": "STAPLETON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "585-395-6095"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS-OUTPATIENT",
            "identifier": "14005907",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00279543",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "PC103050AX",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brockport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2010; 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.