# CARRUS LAKESIDE HOSPITAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Carrus Lakeside Rural Health Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649057431
- **Authorized official:** ANBU NACHIMUTHU (CHAIRMAN/CEO)
- **Authorized official phone:** (903) 870-2745

## Contact information

- **Practice address:** 700 W 7TH AVE STE 102, BRISTOW, OK 74010-2302
- **Practice address phone:** (918) 367-2215
- **Practice address fax:** (918) 367-4481
- **Mailing address:** 1810 W US HIGHWAY 82, SHERMAN, TX 75092-7069
- **Mailing address phone:** (903) 870-2745
- **Mailing address fax:** (903) 870-2795

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/13/2023
- **Last updated:** 09/13/2023