Provider Demographics
NPI:1881829026
Name:LAKESIDE SPINE CENTER
Entity Type:Organization
Organization Name:LAKESIDE SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEE DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-276-6300
Mailing Address - Street 1:8301 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-9320
Mailing Address - Country:US
Mailing Address - Phone:972-276-6300
Mailing Address - Fax:972-862-1085
Practice Address - Street 1:8301 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-9320
Practice Address - Country:US
Practice Address - Phone:972-276-6300
Practice Address - Fax:972-862-1085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALTY AMBULATORY CENTER OF TEXAS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical