MEDICARE: LAKEWOOD HOSPITAL LLC

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
1	282NR1301X	Rural Acute Care Hospital	K 6196	TX

General Provider Information

NPI Number	:	1528386091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD HOSPITAL LLC

Provider Business Mailing Address
First Line	:	8800 S MAIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2707
Country	:	US
Telephone Number	:	713-661-0001
Fax Number	:	713-669-4862

Provider Business Practice Location Address
First Line	:	1001 DICKERSON DR
Second Line	:
City	:	JASPER
State	:	TX
Zip	:	75951-5110
Country	:	US
Telephone Number	:	713-661-0001
Fax Number	:	713-669-4862

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	MS. OLATOKUNBO IFAYEMI ODUTAYO
Credential	:	R.N.
Telephone Number	:	832-859-3932

Provider Enumeration Date	:	05/08/2010
Last Update Date	:	05/08/2010

Similar Medicare Providers

1487650420 — DR. PETER ALEXANDER BIDWELL MD
Practice Location Address:

1007 DICKERSON DR
JASPER, TX
75951-5110

Practice Phone: 409-384-3421
Practice Fax: 409-384-7443

1548483589 — PETER A BIDWELL FAMILY PRACTICE
Practice Location Address:

1007 DICKERSON DR
JASPER, TX
75951-5110

Practice Phone: 409-384-3421
Practice Fax: 409-384-7443

1003939232 — DICKERSON MEMORIAL HOSPITAL, LLC
Practice Location Address:

1001 DICKERSON DR
JASPER, TX
75951-5110

Practice Phone: 409-383-2345
Practice Fax: 281-447-6802

1548439979 — DR. DAVID ANTHONY MOSIG D.O.
Practice Location Address:

1001 DICKERSON DR
JASPER, TX
75951-5110

Practice Phone: 409-383-2337
Practice Fax:

1437758851 — MARQUITA ARNELL KING RN
Practice Location Address:

2402 DONNA DR
JASPER, TX
75951-5915

Practice Phone: 409-594-1355
Practice Fax:

1942203658 — MR. JOHN MICHAEL PAUZAUSKIE CRNA
Practice Location Address:

1275 MARVIN HANCOCK DR
JASPER, TX
75951-4935

Practice Phone: 409-384-5461
Practice Fax:

Directions to “LAKEWOOD HOSPITAL LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.