Organization
LAKESIDE FAMILY PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN W HAWTHORNE M.D. (PRESIDENT)
(304) 594-2400
Entity
Organization
Contact information
Practice address
933 CHEAT RD, MORGANTOWN, WV 26508-5631
(304) 594-2400
(304) 594-2256
Mailing address
933 CHEAT RD, MORGANTOWN, WV 26508-5631
(304) 594-2400
(304) 594-2256
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001709238
BLUE SHIELD GROUP PROVIDE
WV
05
—
3810002243
—
WV
Enumeration date
10/24/2006
Last updated
05/09/2011
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us