Provider Demographics
NPI:1750349890
Name:LAKEPOINT FAMILY PHYSICIANS PA
Entity type:Organization
Organization Name:LAKEPOINT FAMILY PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHRISTIANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-636-2662
Mailing Address - Street 1:8020 E CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2360
Mailing Address - Country:US
Mailing Address - Phone:316-636-2662
Mailing Address - Fax:316-636-2644
Practice Address - Street 1:8020 E CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2360
Practice Address - Country:US
Practice Address - Phone:316-636-2662
Practice Address - Fax:316-636-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3166369295Medicaid
KS0963520001Medicare NSC
KS110033Medicare ID - Type Unspecified