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Organization
LAKESIDE MEMORIAL HOSPITAL INC.
Active
Organization
LAKESIDE MEMORIAL HOSPITAL INC.
Active
Parent organization
LAKESIDE MEMORIAL HOSPITAL INC.
Other names
Lakeside OB/GYN
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKESIDE MEMORIAL HOSPITAL INC.
Authorized official
MS. STACEY SHARE (MEDICAL BILLER)
(585) 637-6040
Entity
Organization
Contact information
Practice address
156 WEST AVE, SUITE 104, BROCKPORT, NY 14420-1229
(585) 637-6040
(588) 637-4737
Mailing address
156 WEST AVE, SUITE 104, BROCKPORT, NY 14420-1229
(585) 637-6040
(588) 637-4737
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
235519
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0027353001
UNIVERA
NY
01
—
00927965001
WNY
NY
05
—
02675890
—
NY
01
—
0712876
INDEPENDENT HEALTH
NY
01
—
170748CK
PREFFERED CARE
NY
01
—
7819729
AETNA
NY
01
—
P010235519
BCBS ROCHESTER
NY
Enumeration date
07/19/2006
Last updated
07/13/2010
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