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General NPI Number Information
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NPI Number | 1336492495
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Entity Type | Organization
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Legal Business Name | LAKESIDE HEALTH CLINIC, P.C.
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 813 E WOOD ST
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City | PARIS
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State | TN
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Zip | 38242-4223
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Country | US
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Telephone | 731-924-2000
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Fax | 731-653-0053
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Provider Business Mailing Address
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Address Line | PO BOX 1269
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City | PARIS
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State | TN
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Zip | 38242-1269
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Country | US
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Telephone | 731-924-2000
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Fax | 731-653-0053
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Authorized Official
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Title or Position | OWNER/PA-C
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Name | LISA HATCH HUBBARD
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Credential | PA-C
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Telephone | 731-924-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice 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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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