Provider Demographics
NPI:1649057431
Name:CARRUS LAKESIDE HOSPITAL LLC
Entity type:Organization
Organization Name:CARRUS LAKESIDE HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANBU
Authorized Official - Middle Name:
Authorized Official - Last Name:NACHIMUTHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-870-2745
Mailing Address - Street 1:1810 W US HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7069
Mailing Address - Country:US
Mailing Address - Phone:903-870-2745
Mailing Address - Fax:903-870-2795
Practice Address - Street 1:700 W 7TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2302
Practice Address - Country:US
Practice Address - Phone:918-367-2215
Practice Address - Fax:918-367-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health