Provider Demographics
NPI:1942621024
Name:CAREPLUS LAKEVIEW FAMILY MEDICINE
Entity Type:Organization
Organization Name:CAREPLUS LAKEVIEW FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NON OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-552-3441
Mailing Address - Street 1:65 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5221
Mailing Address - Country:US
Mailing Address - Phone:601-925-0598
Mailing Address - Fax:601-924-1706
Practice Address - Street 1:65 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5221
Practice Address - Country:US
Practice Address - Phone:601-925-0598
Practice Address - Fax:601-924-1706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVER OAKS MANAGEMENT COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02454Medicare PIN