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
1	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1639376163
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	:	2314 N ORANGE BLOSSOM TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4803
Country	:	US
Telephone Number	:	407-428-9233
Fax Number	:	407-428-9667

Authorized Official
Title or Position	:	VICE PRESIDENT OF OPERATIONS
Name	:	MISS ARLENE GUZIK
Credential	:	ARNP
Telephone Number	:	727-586-0138

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	03/31/2010

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