Provider Demographics
NPI:1154056208
Name:LAKEVIEW TRAUMA AND CRITICAL CARE, LLC
Entity Type:Organization
Organization Name:LAKEVIEW TRAUMA AND CRITICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP VP/AO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:REBOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-5004
Mailing Address - Street 1:PO BOX 748630
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8630
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:
Practice Address - Street 1:101 JUDGE TANNER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7506
Practice Address - Country:US
Practice Address - Phone:985-867-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty