Provider Demographics
NPI:1285687491
Name:LAKEVIEW URGENT CARE AND FAMILY CLINIC, INC.
Entity Type:Organization
Organization Name:LAKEVIEW URGENT CARE AND FAMILY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:910-323-1481
Mailing Address - Street 1:3622 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-1937
Mailing Address - Country:US
Mailing Address - Phone:910-423-7771
Mailing Address - Fax:910-423-4177
Practice Address - Street 1:3622 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1937
Practice Address - Country:US
Practice Address - Phone:910-423-7771
Practice Address - Fax:910-423-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012YEMedicaid
NC012YEOtherBCBS GRP NUMBER
NC89012YEMedicaid