Provider Demographics
NPI:1073562864
Name:LAKESIDE FAMILY MEDICINE, PA
Entity Type:Organization
Organization Name:LAKESIDE FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-224-4003
Mailing Address - Street 1:4120 HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29626-5321
Mailing Address - Country:US
Mailing Address - Phone:864-224-4003
Mailing Address - Fax:864-224-4999
Practice Address - Street 1:4120 HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29626-5321
Practice Address - Country:US
Practice Address - Phone:864-224-4003
Practice Address - Fax:864-224-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2512Medicaid
CG9690Medicare PIN
6767Medicare PIN