Provider Demographics
NPI:1750116984
Name:LB MEDICAL AND AESTHETICS LLC
Entity type:Organization
Organization Name:LB MEDICAL AND AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARWICK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-C
Authorized Official - Phone:850-672-4012
Mailing Address - Street 1:408 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-6330
Mailing Address - Country:US
Mailing Address - Phone:850-672-4012
Mailing Address - Fax:
Practice Address - Street 1:408 ISLAND RD
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-6330
Practice Address - Country:US
Practice Address - Phone:850-672-4012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty