NPIMap

Organization Active NPI

Lakeside Memorial Hospital Inc.

  • General Practice Physician
  • Brockport, NY
National Provider Identifier
1942359989
Registry record updated Mar 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
LAKESIDE MEMORIAL HOSPITAL INC.
Practice address
156 West Ave
Brockport, NY 14420
Phone
(585) 395-6095
Fax
(585) 395-6084
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2011

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

Authorized official

Name
Michelle Kingdollar
Title
Accounts Receivable Manager
Phone
(585) 395-6095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

156 West Ave
Brockport, NY 14420

Mailing address

156 West Ave
Brockport, NY 14420
Phone (585) 395-6095

Other names 1

  • Lakeside Physician Group Other name

National Provider Directory

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

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301011200000",
    "number": "1942359989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "14420",
            "telephone_number": "585-395-6095",
            "fax_number": "585-395-6084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "14420",
            "telephone_number": "585-395-6095",
            "fax_number": "585-395-6084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEMORIAL HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2011-03-25",
        "status": "A",
        "authorized_official_last_name": "KINGDOLLAR",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "ACCOUNTS RECEIVABLE MANAGER",
        "authorized_official_telephone_number": "585-395-6095"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Physician Group",
            "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 Mar 25, 2011; 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.