Provider Demographics
NPI:1407053069
Name:LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.
Entity Type:Organization
Organization Name:LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:727-532-7647
Mailing Address - Street 1:7527 ULMERTON RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4548
Mailing Address - Country:US
Mailing Address - Phone:727-586-0138
Mailing Address - Fax:727-586-6954
Practice Address - Street 1:2323 CURLEW RD
Practice Address - Street 2:SUITES 2A & 2B
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9330
Practice Address - Country:US
Practice Address - Phone:727-781-3480
Practice Address - Fax:727-781-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine