Provider Demographics
NPI:1245389311
Name:LAKE PARK MEDICAL CARE CENTER INC
Entity Type:Organization
Organization Name:LAKE PARK MEDICAL CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER BILLING COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-748-2889
Mailing Address - Street 1:415 US HIGHWAY 1
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3585
Mailing Address - Country:US
Mailing Address - Phone:561-842-5900
Mailing Address - Fax:561-844-6037
Practice Address - Street 1:415 US HIGHWAY 1
Practice Address - Street 2:SUITE D
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-3585
Practice Address - Country:US
Practice Address - Phone:561-842-5900
Practice Address - Fax:561-844-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50430Medicare UPIN
FL02280YMedicare ID - Type Unspecified