Provider Demographics
NPI:1720572407
Name:ESSENTIAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:ESSENTIAL HEALTHCARE LLC
Other - Org Name:LAKESIDE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-266-1544
Mailing Address - Street 1:1260 CHESNUT BYP STE A
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-2834
Mailing Address - Country:US
Mailing Address - Phone:256-266-1544
Mailing Address - Fax:256-266-1531
Practice Address - Street 1:1260 CHESNUT BYPASS
Practice Address - Street 2:SUITE A
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-2834
Practice Address - Country:US
Practice Address - Phone:256-266-1544
Practice Address - Fax:256-266-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL224799Medicaid