North Lagoon Medical, LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA3330 Issued in FL

Legal business name

NORTH LAGOON MEDICAL, LLC

Practice address

8317 Front Beach Rd Ste 37B
Panama City Beach, FL 32407-4896

Phone

(352) 504-8546

NPI assigned

Jun 20, 2013

Organization subpart

No

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

Authorized official

Name

Ronald Joseph Aldridge, PA

Title

MGR

Phone

(352) 504-8546

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Crest Medical Center Doing business as

Locations

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

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371686400000",
    "number": "1770922007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8317 FRONT BEACH RD",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324074885",
            "telephone_number": "352-504-8546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8317 FRONT BEACH RD STE 37B",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324074896",
            "telephone_number": "352-504-8546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH LAGOON MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-20",
        "last_updated": "2013-06-20",
        "status": "A",
        "authorized_official_last_name": "ALDRIDGE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "352-504-8546",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA3330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292267300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "S74011",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y0A3J",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crest Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physician Assistant in Panama City Beach, FL
• Providers in Panama City Beach, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; 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.