Provider Demographics
NPI:1134682263
Name:LA LAKERS
Entity Type:Organization
Organization Name:LA LAKERS
Other - Org Name:NATIONAL BASKETBALL ASSOICATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:184-462-2855
Mailing Address - Street 1:2101 NE 2ND ST APT 114
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-8626
Mailing Address - Country:US
Mailing Address - Phone:352-792-8069
Mailing Address - Fax:
Practice Address - Street 1:2101 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-8627
Practice Address - Country:US
Practice Address - Phone:352-792-8069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA LAKERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-06
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0217-792-8069-411OtherCOUNSLER