Provider Demographics
NPI:1649471814
Name:LAKE LEWISVILLE PEDIATRICS, LLP
Entity type:Organization
Organization Name:LAKE LEWISVILLE PEDIATRICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-315-8500
Mailing Address - Street 1:2141 S EDMONDS LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6162
Mailing Address - Country:US
Mailing Address - Phone:972-315-8500
Mailing Address - Fax:
Practice Address - Street 1:2141 S EDMONDS LN
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6162
Practice Address - Country:US
Practice Address - Phone:972-315-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care