Lakeside Memorial Hospital Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

235519 Issued in NY

Legal business name

LAKESIDE MEMORIAL HOSPITAL INC.

Practice address

156 West Ave
Suite 104
Brockport, NY 14420-1229

Phone

(585) 637-6040

Fax

(588) 637-4737

NPI assigned

Jul 19, 2006

Organization subpart

Yes

Parent organization

LAKESIDE MEMORIAL HOSPITAL INC.As reported in NPPES

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

Authorized official

Name

Ms. Stacey Share

Title

Medical Biller

Phone

(585) 637-6040

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Lakeside OB/GYN Other name

Part of

Internal Medicine at Lakeside

Locations

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278979200000",
    "number": "1972522670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 WEST AVE",
            "address_2": "SUITE 104",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201229",
            "telephone_number": "585-637-6040",
            "fax_number": "588-637-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 WEST AVE",
            "address_2": "SUITE 104",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201229",
            "telephone_number": "585-637-6040",
            "fax_number": "588-637-4737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEMORIAL HOSPITAL INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKESIDE MEMORIAL HOSPITAL INC.",
        "enumeration_date": "2006-07-19",
        "last_updated": "2010-07-13",
        "status": "A",
        "authorized_official_last_name": "SHARE",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "MEDICAL BILLER",
        "authorized_official_telephone_number": "585-637-6040",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "235519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "0712876",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7819729",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "0027353001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ROCHESTER",
            "identifier": "P010235519",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WNY",
            "identifier": "00927965001",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02675890",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFFERED CARE",
            "identifier": "170748CK",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside OB/GYN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lakeside Memorial Hospital Inc.
• Lakeside Memorial Hospital Inc.
• Lakeside Memorial Hospital Inc.
• Lakeside Memorial Hospital Inc.
• Lakeside Memorial Hospital Inc.
• Rebecca Landis, RN
• Ben Louis Laplante, DO
• Emma Leatham, PA-C
• Theresa Fox Lehman, MSED.
• William David Leicht, DDS

• Specialist in Brockport, NY
• Providers in Brockport, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.