Provider Demographics
NPI:1295864833
Name:LAKEWOOD MEDICAL CENTER
Entity Type:Organization
Organization Name:LAKEWOOD MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HAI
Authorized Official - Middle Name:PHONG
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-238-1488
Mailing Address - Street 1:2020 WADSWORTH BLVD
Mailing Address - Street 2:#17
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5728
Mailing Address - Country:US
Mailing Address - Phone:303-238-1488
Mailing Address - Fax:
Practice Address - Street 1:2020 WADSWORTH BLVD
Practice Address - Street 2:#17
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5728
Practice Address - Country:US
Practice Address - Phone:303-238-1488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33410OtherSTATE LISCENSE
CO01334101Medicaid
COC477118Medicare ID - Type Unspecified
CO01334101Medicaid