NPIMap

Organization Active NPI

Lakeside Surgery, P.a.

  • Specialist
  • Rockwall, TX
National Provider Identifier
1851489520
Registry record updated Jun 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
K6483 Issued in TX
Legal business name
LAKESIDE SURGERY, P.A.
Practice address
3142 Horizon Rd
Suite 206
Rockwall, TX 75032-7809
Phone
(972) 722-3290
Fax
(469) 402-2585
NPI assigned
Oct 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2013

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

Authorized official

Name
Katherine R Makohon, MDNPI 1952393415
Title
Surgeon/Owner
Phone
(972) 722-3290

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X K6483 TX Primary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X J2983 TX
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X P6593 TX

Addresses

Primary practice location

3142 Horizon Rd
Suite 206
Rockwall, TX 75032-7809

Mailing address

2850 Shoreline TRL
PMB 154
Rockwall, TX 75032-5508
Phone (972) 772-3290

Other identifiers 2

IdentifierTypeStateIssuer
1326097676OtherTXNPI
1952393415OtherTXNPI

Other names 1

  • LAKESIDE SURGERY, P.A. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kenneth L Bryce MD PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

3142 Horizon Rd
Ste 206
Rockwall, TX 75032
Phone (469) 698-1048

1005 W Ralph Hall Pkwy
Ste 221
Rockwall, TX 75032
Phone (972) 771-9000

1553 Highway 34 S
Ste 500
Terrell, TX 75160
Phone (972) 772-4333

Practitioners & affiliated clinicians

Practitioners 2

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": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370563200000",
    "number": "1851489520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 SHORELINE TRL",
            "address_2": "PMB 154",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750325508",
            "telephone_number": "972-772-3290",
            "fax_number": "469-402-2585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3142 HORIZON RD",
            "address_2": "SUITE 206",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750327809",
            "telephone_number": "972-722-3290",
            "fax_number": "469-402-2585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE SURGERY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2013-06-07",
        "status": "A",
        "authorized_official_last_name": "MAKOHON",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SURGEON/OWNER",
        "authorized_official_telephone_number": "972-722-3290",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "K6483",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "J2983",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "P6593",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1326097676",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1952393415",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKESIDE SURGERY, P.A.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockwall, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.