Lakeside Pediatric & Adolescent Medicine, Pllc
Pediatric Adolescent Medicine
Lakeside Pediatric & Adolescent Medicine, Pllc is a Coeur D'alene, Idaho based Pediatric center with medical specialization in
Pediatric Adolescent Medicine.
It is located at
980 W Ironwood Dr, Ste 302, Coeur D'alene, Idaho - 83814-2601. They can be contacted on phone at
208-292-5437 and fax number 208-292-5441.
NPI number (Unique professional ID) for Lakeside Pediatric & Adolescent Medicine, Pllc is
1003975087 which was assigned by NPPES on 06 Dec, 2006 and it was last updated on 12 Jul, 2012.
Lakeside Pediatric & Adolescent Medicine, Pllc specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
Complete Profile:
Lakeside Pediatric & Adolescent Medicine, Pllc basic information including their official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics Adolescent Medicine |
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| Provider Name : | Lakeside Pediatric & Adolescent Medicine, Pllc |
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Business Address:
Lakeside Pediatric & Adolescent Medicine, Pllc address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | 980 W Ironwood Dr, Ste 302
Coeur D'alene, ID, 83814-2601
United States |
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| Phone Number : | 208-292-5437 |
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| Fax Number : | 208-292-5441 |
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Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1003975087 |
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| NPI Entity Type : | Organization |
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| First Enrolment Date : | 06 Dec, 2006 |
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| Last Updated On : | 12 Jul, 2012 |
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Authorized Official Details:
Officially authorized person to contact for any management issues or complaints of this organization are as below. Person's position and contact details are as mentioned below.
| Authorized Official Name : | Dianar Vanhook |
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| Official Title or Position : | OFFICE MANAGER |
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| Phone Number : | 208-292-5437 |
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Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Lakeside Pediatric & Adolescent Medicine, Pllc are as mentioned. Primary taxonomy code for Lakeside Pediatric & Adolescent Medicine, Pllc is
2080A0000X (Pediatrics Adolescent Medicine).
| Taxonomy Code | Speciality | Primary | License No. | State |
|---|
| 2080A0000X | Pediatrics Adolescent Medicine | Yes | | |
Legacy Identifiers:
Other legacy medical identifiers of Lakeside Pediatric & Adolescent Medicine, Pllc such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
|---|
| 806408200 | MEDICAID | ID | |
| 4010138351 | Other | ID | REGENCE BLUE SHIELD GROUP |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | 980 W Ironwood Dr, Ste 302
Coeur D'alene, ID, 83814-2601
United States |
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| Phone Number : | 208-292-5437 |
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| Fax Number : | 208-292-5441 |
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Business Location:
Patients can refer following map for directions to
Lakeside Pediatric & Adolescent Medicine, Pllc practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 January, 2024.