Lakeside Family Practice Pllc | |
933 Cheat Rd Morgantown WV 26508-5631 | |
(304) 594-2400 | |
(304) 594-2256 |
Full Name | Lakeside Family Practice Pllc |
---|---|
Speciality | Family Medicine |
Location | 933 Cheat Rd, Morgantown, West Virginia |
Authorized Official Name and Position | Brian W Hawthorne (PRESIDENT) |
Authorized Official Contact | 3045942400 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Lakeside Family Practice Pllc 933 Cheat Rd Morgantown WV 26508-5631 Ph: (304) 594-2400 | Lakeside Family Practice Pllc 933 Cheat Rd Morgantown WV 26508-5631 Ph: (304) 594-2400 |
NPI Number | 1205919917 |
---|---|
Provider Enumeration Date | 10/24/2006 |
Last Update Date | 05/09/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205919917 | NPI | - | NPPES |
001709238 | Other | WV | BLUE SHIELD GROUP PROVIDE |
3810002243 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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