Lakeside Family Practice

LBN: Lakeside Family Practice
Lakeside Family Practice is an health care organization with primary practice located at 3200 Sheridan Rd Ste 104 , Kenosha WI 53140-1921. The organization recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Family is the primary health care specialty. Lakeside Family Practice can be contacted via phone (262) 225-1014, or through Hale, Anthony via phone (262) 225-1014.

Contact Information

Primary practice address
3200 Sheridan Rd Ste 104 Kenosha WI 53140-1921
Phone: (262) 225-1014
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Hale, Anthony DNP, FNP-BC
Phone: (262) 225-1014

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2011006054 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 6190-33 Wisconsin

Profile Details

NPI number 1831698430
LBN Legal business name Lakeside Family Practice
DBA Doing business as
Authorized official Hale, Anthony DNP, FNP-BC
Entity Organization
Organization subpart 1 No
Enumeration date Feb 8th, 2018
Last updated Feb 8th, 2018 - about 8 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831698430 NPPES
Wisconsin MEDICAID 100043522
Wisconsin MEDICAID 100018824

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