Provider Demographics
NPI:1093165631
Name:LAKEWAY COMPLETE CARE LLC
Entity Type:Organization
Organization Name:LAKEWAY COMPLETE CARE LLC
Other - Org Name:VIK COMPLETE CARE LAKEWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRAXTON
Authorized Official - Last Name:NEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:817-421-0034
Mailing Address - Street 1:PO BOX 92756
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0756
Mailing Address - Country:US
Mailing Address - Phone:817-421-0034
Mailing Address - Fax:817-421-0036
Practice Address - Street 1:1518 RANCH ROAD 620 S
Practice Address - Street 2:100
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6291
Practice Address - Country:US
Practice Address - Phone:817-421-0034
Practice Address - Fax:817-421-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care