Provider Demographics
NPI:1528546736
Name:LAKELINE EMERGENCY CENTER, LLC
Entity Type:Organization
Organization Name:LAKELINE EMERGENCY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-948-1752
Mailing Address - Street 1:1464 E WHITESTONE BLVD STE 1101
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-9070
Mailing Address - Country:US
Mailing Address - Phone:512-309-8925
Mailing Address - Fax:
Practice Address - Street 1:1860 S. LAKELINE BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-260-2732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care