Provider Demographics
NPI:1477507168
Name:LAKESIDE SURGERY LLC
Entity Type:Organization
Organization Name:LAKESIDE SURGERY LLC
Other - Org Name:LAKESIDE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:078-938-2004
Mailing Address - Street 1:1825 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803
Mailing Address - Country:US
Mailing Address - Phone:407-206-2375
Mailing Address - Fax:407-206-2377
Practice Address - Street 1:1825 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-206-2375
Practice Address - Fax:407-206-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306OtherWELLCARE
FL490003489OtherMEDICARE RAILROAD
FL638OtherBCBS
FL079231400Medicaid
FL638OtherBCBS