Provider Demographics
NPI:1013327527
Name:COMMUNITY URGENT CARE LAKESIDE NORTH
Entity Type:Organization
Organization Name:COMMUNITY URGENT CARE LAKESIDE NORTH
Other - Org Name:LAKESIDE NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-571-8581
Mailing Address - Street 1:38 ROWE DR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7367
Mailing Address - Country:US
Mailing Address - Phone:256-571-8460
Mailing Address - Fax:256-571-8464
Practice Address - Street 1:38 ROWE DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7367
Practice Address - Country:US
Practice Address - Phone:256-571-8460
Practice Address - Fax:256-571-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty