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General NPI Number Information
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NPI Number | 1184517922
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Entity Type | Organization
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Legal Business Name | LAKESIDE MED PLLC
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 3619 PAESANOS PKWY STE 300
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City | SAN ANTONIO
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State | TX
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Zip | 78231-1263
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Country | US
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Telephone | 210-338-6328
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Fax |
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Provider Business Mailing Address
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Address Line | 1141 NORTH LOOP 1604 EAST #105-PMB616
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City | SAN ANTONIO
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State | TX
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Zip | 78232-3624
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. OM NEELEY
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Credential |
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Telephone | 210-338-6328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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