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NPI Code Detail

MEDICARE: LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.

MEDICARE: LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QX0100XOccupational Medicine Clinic/Center

General Provider Information

NPI Number : 1770780272
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.
Provider Business Mailing Address
First Line : 7527 ULMERTON RD
Second Line :
City : LARGO
State : FL
Zip : 33771-4548
Country : US
Telephone Number : 727-586-0138
Fax Number : 727-586-6954
Provider Business Practice Location Address
First Line : 1750 N 50TH ST
Second Line :
City : TAMPA
State : FL
Zip : 33619-3104
Country : US
Telephone Number : 813-247-4489
Fax Number : 813-247-4480
Authorized Official
Title or Position : VICE PRESIDENT OF OPERATIONS
Name : SANDRA L. DRIVER
Credential : R.N.
Telephone Number : 727-532-7647
Provider Enumeration Date : 06/28/2007
Last Update Date : 07/21/2009

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Directions to “LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC. ” Practice Location

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