| Lakeside Medical Pllc | |
|
300 W White Mountain Blvd #c Lakeside AZ 85929-7014 | |
| (928) 367-6828 | |
| (928) 367-4037 |
| Full Name | Lakeside Medical Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 300 W White Mountain Blvd #c, Lakeside, Arizona |
| Authorized Official Name and Position | Gaylon E Crawford (PHYSICIAN) |
| Authorized Official Contact | 9283676828 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Medical Pllc 300 W White Mountain Blvd #c Lakeside AZ 85929-7014 Ph: (928) 367-6828 | Lakeside Medical Pllc 300 W White Mountain Blvd #c Lakeside AZ 85929-7014 Ph: (928) 367-6828 |
| NPI Number | 1376210500 |
|---|---|
| Provider Enumeration Date | 08/25/2021 |
| Last Update Date | 03/16/2022 |
| Medicare PECOS PAC ID | 9335535913 |
|---|---|
| Medicare Enrollment ID | O20220407001030 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376210500 | NPI | - | NPPES |
| 368333 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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