MEDICARE: LAKESIDE HOSPITAL AT BASTROP, LTD

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	282N00000X	General Acute Care Hospital	008314	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	HH1113	OTHER	TEXAS BLUECROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851323240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESIDE HOSPITAL AT BASTROP, LTD

Provider Business Mailing Address
First Line	:	3201 HIGHWAY 71 E
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-5126
Country	:	US
Telephone Number	:	512-321-8200
Fax Number	:	512-321-8701

Provider Business Practice Location Address
First Line	:	3201 HIGHWAY 71 E
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-5126
Country	:	US
Telephone Number	:	512-321-8200
Fax Number	:	512-321-8701

Authorized Official
Title or Position	:	DIRECTOR OF ACCOUNTING
Name	:	PEGGY BORGFELD
Credential	:
Telephone Number	:	512-321-8200

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	12/16/2008

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