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Organization
LAKESIDE MEMORIAL HOSPITAL INC.
Active
Organization
LAKESIDE MEMORIAL HOSPITAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL STAPLETON (CEO)
(585) 395-6095
Entity
Organization
Contact information
Practice address
156 WEST AVE, BROCKPORT, NY 14420-1229
(585) 395-6095
(585) 395-6036
Mailing address
156 WEST AVE, BROCKPORT, NY 14420-1229
(585) 395-6095
(585) 395-6036
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
—
NY
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00279543
—
NY
01
—
02198570
MEDICAID-PHYS & MID PRACT
NY
01
—
100003CF
PREFERRED CARE
NY
01
—
106418AZ
PREFERRED CARE-PHYS & MID
NY
01
—
12005907
EXCELLUS - INPATIENT
NY
01
—
14005907
EXCELLUS - OUTPATIENT
NY
01
—
70000A
MEDICARE-PHYS & MID PRACT
NY
Enumeration date
04/27/2006
Last updated
08/25/2009
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