# LAKESIDE FAMILY HEALTH CENTER PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871564609
- **Authorized official:** CHARLES ROBERTSON MD (OWNER)
- **Authorized official phone:** (928) 537-4379

## Contact information

- **Practice address:** 5658 HIGHWAY 260, SUITE 24, LAKESIDE, AZ 85929-5189
- **Practice address phone:** (928) 537-4379
- **Practice address fax:** (928) 537-4653
- **Mailing address:** 5658 HIGHWAY 260 STE 24, LAKESIDE, AZ 85929-5189
- **Mailing address phone:** (928) 537-4379

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LW0102X | Women's Health Nurse Practitioner | — | NULL | — |
| 363LW0102X | Women's Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/30/2006
- **Last updated:** 01/26/2015